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Publication Detail
Analysis of metastases rates during follow-up after endoscopic resection of early "high-risk" esophageal adenocarcinoma
  • Publication Type:
    Journal article
  • Authors:
    Nieuwenhuis EA, van Munster SN, Meijer SL, Brosens LAA, Jansen M, Weusten BLAM, Herrero LA, Alkhalaf A, Schenk E, Schoon EJ, Curvers WL, Koch AD, van de Ven SEM, Verheij EPD, Nagengast WB, Westerhof J, Houben MHMG, Tang T, Bergman JJGHM, Pouw RE, Dutch Barrett Expert Centers
  • Publisher:
    Elsevier BV
  • Publication date:
  • Pagination:
    237, 247.e3
  • Journal:
    Gastrointestinal Endoscopy
  • Volume:
  • Issue:
  • Medium:
  • Status:
  • Country:
    United States
  • PII:
  • Language:
  • Keywords:
    endoscopic therapy, esophageal adenocarcinoma, histopathological risk factors, metastases
  • Notes:
    © 2022 by the American Society for Gastrointestinal Endoscopy. Published by Elsevier, Inc. under a Creative Commons license (https://creativecommons.org/licenses/by/4.0/).
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.
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