Background Current endoscopic therapy for neoplastic
Barrett’s oesophagus (BO) consists of complete
resection/ablation of all Barrett’s tissue including
neoplastic lesions. Recurrence seems to be frequent after
thermal therapy, such as radiofrequency ablation.
Objective To analyse long-term recurrence of
neoplasia and BO after successful widespread
endoscopic mucosal resection (EMR).
Design In a retrospective analysis, all patients
undergoing widespread EMR of neoplastic BO between
2002 and 2007 at two referral centres were followed for
at least 3 years after completion of endotherapy.
Recurrence was diagnosed if neoplasia and/or BO were
detected following previous successful complete removal,
defined as at least two negative endoscopies and
biopsies.
Results Ninety patients undergoing widespread EMR
were included (mean age 63 years; 82 male), 58% of
whom underwent additional thermal ablation for minor
residual disease. Complete eradication of neoplasia and
Barrett’s tissue was achieved in 90% of patients. On
further follow-up (mean 64.8 months), recurrence of
neoplastic and non-neoplastic BO was found in 6.2%
and 39.5%, respectively. Recurring neoplasia (3
adenocarcinomas, 1 low-grade and 1 high-grade
dysplasia) were found after a median of 44 months
(range 38–85) and could be retreated endoscopically. In
a multivariate analysis, Barrett’s length was the only
factor significantly associated with recurrence (OR 2.73).
Conclusions Even after seemingly complete
endoscopic resection, recurrence of BO is frequent and
independent of additional thermal therapy. Due to the
possibility of neoplasia recurrence even after long
disease-free intervals, follow-up should be extended
beyond 5 years.