Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma

Esther A Nieuwenhuis, Sanne N van Munster, Sybren L Meijer, Lodewijk A A Brosens, Marnix Jansen, Bas L A M Weusten, Lorenza Alvarez Herrero, Alaa Alkhalaf, Ed Schenk, Erik J Schoon, Wouter L Curvers, Arjun D Koch, Steffi E M van de Ven, Eva P D Verheij, Wouter B Nagengast, Jessie Westerhof, Martin H M G Houben, Thjon Tang, Jacques J G H M Bergman, Roos E Pouw*Dutch Barrett Expert Centers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND AND AIMS: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histological features for lymph node metastases (LNM) (i.e., submucosal invasion, poor differentiation grade, or lymphovascular invasion (LVI)), remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC.

METHODS: For this retrospective cohort study, data was collected from all Dutch patients managed with endoscopic follow-up (endoscopy, endoscopic ultrasound) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. Primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology.

RESULTS: A total of 120 patients met the selection criteria. Median FU was 29 months (IQR 15-48). Metastases were observed in 5/25 (annual risk 6.9%; 95% CI 3.0-15), 1/55 (annual risk 0.7%; 95% CI 0-4.0) and 3/40 (annual risk 3.0%; 95% CI 0-7.0) in high-risk intramucosal, low-risk submucosal, and high-risk submucosal cancers, respectively.

CONCLUSIONS: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.

Original languageEnglish
Pages (from-to)237-247.E3
Number of pages14
JournalGastrointestinal Endoscopy
Volume96
Issue number2
Early online date11 Mar 2022
DOIs
Publication statusPublished - Aug 2022

Keywords

  • BARRETTS-ESOPHAGUS
  • HIGH-GRADE DYSPLASIA
  • MANAGEMENT
  • MORTALITY

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