title: Endotherapy in case of relapse of neoplastic Barrett's esophagus after successful initial endoscopic resection.
abstract: Endotherapy in cases of neoplastic Barrett esophagus (BE) relapse after successful initial endoscopic management is commonly accepted, but few studies analyze this topic and also take into account the metachronous lesions.
  
  
  
  To evaluate the efficiency of endotherapy in the case of neoplastic BE relapse after successful complete endoscopic eradication of neoplastic BE and metaplastic BE.
  
  
  
  Retrospective review of medical records was collected in a computerized and prospective manner between 2000 and 2015, in a single tertiary care center. Recurrence was defined by histological presence of high-grade dysplasia or superficial adenocarcinoma at least 6 months after the end of successful initial endotherapy.
  
  
  
  Eighteen patients were assessed (1F/17 M). Delay between initial treatment and relapse was 16.6 months (range 6-33). Endotherapy for relapse obtained a sustained and complete remission for 8/18 (44%) patients, with an average endoscopic follow-up of 28 months. The complication rate of endotherapy was 6%. Surgical management was required in 33% (2 pT2N0M0, 2 pTisN0M0, 1 pTm2N0M0 and 1 pTm3N0M0) and salvage radiochemotherapy in 17% (3/18). One patient treated by 6 sessions of ER was considered as a failure given the multiple sessions of endotherapy. Multivariate analysis showed that length of BE (>5 cm), late stenosis adverse events and the quality of vertical margin during initial ER are predictive factors for disease-free survival (p value < 0.01, Hazard Ratio up to 0.076).
  
  
  
  Endotherapy could be a treatment for management of neoplastic BE relapse, but should be carefully used, with strict follow-up.
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France. tagodat@gmail.com.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Godat
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Division of Biostatistics, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Autret
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Ratone
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Chiara
authors.initials: C
authors.lastname: De Cassan
authors.affiliation: Division of Pathology, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Flora
authors.initials: F
authors.lastname: Poizat
authors.affiliation: Division of Gastroenterology, Paoli-Calmettes Institute, 232 Boulevard Sainte Marguerite - BP 156, 13273, Marseille Cedex 9, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
keywords: Endoscopic mucosal resection; Endoscopic resection; Endoscopic submucosal dissection; Neoplastic Barrett’s esophagus; Radiofrequency; Relapse