Despite excellent survival following endoscopic resection of early-stage (T1) adenocarcinoma of the esophagus, the disease can recur after many years, suggests a study presented at the annual meeting of the American College of Gastroenterology (ACG). Patients who do not develop complete remission of intestinal metaplasia (CRIM) at follow-up examinations are twice more likely to suffer recurrence.¹

Data of 98 patients from four tertiary academic centers who had undergone endoscopic resection of T1 esophageal adenocarcinoma were reviewed. Participants were followed up for a minimum of five years. CRIM was defined as “negative biopsies from the tubular esophagus and the gastroesophageal junction at one posttreatment surveillance endoscopy”. Recurrence by two years was considered early recurrence.

Ninety-five percent (93/98) of patients were in remission and 84% (82/98) showed CRIM after average follow-up period of 8.76 years. Of the 16 patients with recurrence, 57% had early recurrence at median 0.75 years, while 43% developed recurrence at median 7.7 years. Five of the 93 patients in remission had recurrence after 5 years. Recurrence rate was significantly lower (11% vs 46%) and occurred later (median 5.20 years vs 0.81 years) in patients who achieved CRIM. The overall mortality associated with the adenocarcinoma was 6.45%.

This study underscores the need for continued surveillance in patients with early-stage esophageal adenocarcinoma after surgery, even in those who show no disease recurrence, given the significantly lower recurrence rate in patients who had CRIM. Patients should have regular access to surveillance endoscopies and CT scans. The authors suggest that “CRIM should be considered the most significant endpoint for endotherapy of T1 EAC”.

Reference

Song K, et al. Long-term (> 5 year) outcomes of endoscopic resection for T1 esophageal adenocarcinoma: a multicenter cohort study. Am J Gastroenterol. October 2021;116:pS154, doi: 10.14309/01.ajg.0000773896.61781.22.