title: Neoplastic Barrett's oesophagus and long-term follow-up after endoscopic therapy: complete histological eradication of Barrett associated with high-grade dysplasia significantly decreases neoplasia relapse.
abstract: Endotherapy (ET) has replaced surgery as the first-line treatment of high-grade dysplasia (HGD)/superficial ECA (ECAs) from Barrett's oesophagus (BO). However, long-term follow-up and predictive factors of relapse are not so well studied. The aim of the following study was to evaluate the efficiency of ET for treatment of HGD/ECAs and to determine factors of long-term efficiency.
  
  
  
  ET procedures were manually reported and registered in a hospital data base from March 2000 to July 2010. Inclusion criteria were HGD/ECA on pre-resection biopsies, complete histological and sufficient oncological resection of HGD/ECAs, and complete macroscopic resection of metaplastic BO. Sixty patients (53 men, mean age = 65 years) were included.
  
  
  
  Median follow-up was 66 months [range 42-80]. Complete eradication of residual histological metaplastic BO occurred in 29 patients (48 %). Relapse rate at 36 months was 16.6 % (n = 10) and was unchanged at 60 months of follow-up. There was only one relapse (3.4 %) in case of complete eradication of metaplastic BO and 9 (31 %) in case of incomplete eradication. In univaried and multi-varied analysis, complete eradication of metaplastic BO (p < 0.05) and BO length <5 cm (p < 0.05) were predictive of neoplastic BO non relapse. The length of BO remained a prognostic factor for disease-free survival (DFS). When these preponderant data were cancelled out in multi-varied analysis, complete eradication of BO was a prognostic factor for DFS (p < 0.05).
  
  
  
  Complete histological eradication of BO by ET significantly decreases the rate of neoplasia relapse.
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France. fcaillol@free.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Godat
authors.affiliation: Statistic Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Autret
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Jean Phillippe
authors.initials: JP
authors.lastname: Ratone
authors.affiliation: Pathology Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Flora
authors.initials: F
authors.lastname: Poizat
authors.affiliation: Surgery Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Guiramand
authors.affiliation: Surgery Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Delpero
authors.affiliation: Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000517:prevention & control*; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Barrett’s oesophagus; DHG; ECA; Endoscopic resection; Follow-up