Endoscopy 2022; 54(S 01): S92-S93
DOI: 10.1055/s-0042-1744782
Abstracts | ESGE Days 2022
ESGE Days 2022 Oral presentations
10:00–11:00 Saturday, 30 April 2022 Club A. Barrett's Related neoplasia: is endoscopythe cure?

ENDOSCOPIC FOLLOW-UP OF RADICALLY RESECTED SUBMUCOSAL ADENOCARCINOMA IN BARRETT’S ESOPHAGUS: EARLY RESULTS OF AN ONGOING PROSPECTIVE, INTERNATIONAL, MULTICENTER COHORT REGISTRY (PREFER TRIAL)

M.W. Chan
1   Amsterdam University Medical Centers, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
E.A. Nieuwenhuis
1   Amsterdam University Medical Centers, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
M. Jansen
2   University College London Hospital NHS Trust, Histopathology, London, United Kingdom
,
K. Belghazi
1   Amsterdam University Medical Centers, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
W.B. Nagengast
3   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
J. Westerhof
3   University Medical Center Groningen, Gastroenterology and Hepatology, Groningen, Netherlands
,
A.D. Koch
4   Erasmus MC Cancer Institute, University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
M.D.W. Spaander
4   Erasmus MC Cancer Institute, University Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
,
R. Bisschops
5   University Hospitals Leuven, Gastroenterology and Hepatology, Leuven, Belgium
,
G. De Hertogh
6   University Hospitals Leuven, Pathology, Leuven, Belgium
,
M.J. Bourke
7   Westmead Hospital, Gastroenterology and Hepatology, Sydney, Australia
,
H. Neuhaus
8   Evangelisches Krankenhaus Düsseldorf, General Internal Medicine and Gastroenterology, Düsseldorf, Germany
,
B.L.A.M. Weusten
9   Sint Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands
10   University Medical Center, Utrecht University, Gastroenterology and Hepatology, Utrecht, Netherlands
,
A. Alkhalaf
11   Isala Clinics, Gastroenterology and Hepatology, Zwolle, Netherlands
,
O. Pech
12   St John of God Hospital, Gastroenterology, Regensburg, Germany
,
C. Schlag
13   Technical University of Munich, II, Klinikum rechts der Isar der, München, Germany
,
S. Seewald
14   Klinik Hirslanden, GastroZentrum, Zurich, Switzerland
,
M.H.M.G. Houben
15   Haga Teaching Hospital, Gastroenterology and Hepatology, Den Haag, Netherlands
,
E.J. Schoon
16   Catharina Hospital, Gastroenterology and Hepatology, Eindhoven, Netherlands
,
E. Coron
17   Nantes University Hospital, Endoscopy and Gastroenterology, Nantes, France
,
R. Haidry
18   University College Hospital NHS Trust, Gastroenterology and Hepatology, London, United Kingdom
,
H. Messmann
19   University Hospital Augsburg, Gastroenterology, Augsburg, Germany
,
S.L. Meijer
20   Amsterdam University Medical Centers, Histopathology, Amsterdam, Netherlands
,
J.J.G.H.M. Bergman
1   Amsterdam University Medical Centers, Gastroenterology and Hepatology, Amsterdam, Netherlands
,
R.E. Pouw
1   Amsterdam University Medical Centers, Gastroenterology and Hepatology, Amsterdam, Netherlands
› Author Affiliations
› Further Information
Also available at
 

Aims Endoscopic follow-up (FU) may be a valid alternative for patients with submucosal esophageal adenocarcinoma (T1b EAC) We aim to evaluate the safety of a watchful waiting strategy in patients treated endoscopically for T1b EAC.

Methods This international, multicenter, prospective study aims to include 141 patients (T1b EAC R0 N0M0) with 5-year FU. Patients undergo gastroscopy and EUS every 3 months (year 1 and 2), then every 6 months (year 3 and 4) and annually thereafter. The cohort was divided into high-risk (invasion≥500um, G3-4 and/or LVI+) and low-risk (<500um, G1-2 and LVI-). Outcome parameters: 5-year disease specific survival, overall survival, rate of lymph node metastasis (LNM) and local recurrence.

Results 50 high-risk and 29 low-risk patients (66 men, median 70yo) were included (median FU 19 (IQR 11-30) months). Three patients (4% [95%CI 0-8.1]) developed LNM: 2/50 high-risk (4% [95%CI 0-9.6]) and 1/29 low-risk (4% [95%CI 0-10.5]). Two patients underwent neoadjuvant chemo(radio)therapy with esophagectomy (ypT0N0M0 and ypT0N1M0). One patient underwent selective surgical LN resection. Four patients (5% [95%CI 0-10.0]) developed an intra-luminal recurrence not amenable to endoscopic re-treatment: 3/50 high-risk (6% [95%CI 0-12.8]) and 1/29 low-risk (4% [95%CI 0-10.5]). Two patients underwent esophagectomy (pT1bN0M0 and pTisN0M0). Two patients refused treatment. No distant metastases were diagnosed. Two patients died (not EAC-related). One patient discontinued FU (old age).

Table 1

N=79

FU (months),Median (IQR)

Lymph node metastasis,N (% [95%CI])

Intra-luminal tumor recurrence* ,N (% [95%CI])

Distant metastasis, N (%)

High-risk T1b(N=50)

19 (11-29)

2 (4.0% [0-9.6%])

3 (6.0% [0-12.8%])

0

Low-risk T1b(N=29)

20 (11-30)

1 (3.5% [0-10.5%])

1 (3.5% [0-10.5%])

0

Conclusions Early data suggest that after radical endoscopic resection of T1b EAC, a strict endoscopic FU protocol is feasible and curative surgery remains possible in case of LNM (4%) or local recurrence (5%) during FU.



Publication History

Article published online:
14 April 2022

© 2022. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany