ALL-CAUSE MORTALITY AFTER SUCCESSFUL ENDOSCOPIC ERADICATION THERAPY FOR BARRETT’S RELATED NEOPLASIA IN A NATIONWIDE COHORT OF 1154 PATIENTS

Aims Follow-up after successful endoscopic eradication therapy (EET) for Barrett’s neoplasia is strict. Post-EET recurrence detection rates per endoscopy are low and follow-up may be too aggressive. Furthermore, data on competing causes of mortality are not considered. We aimed to evaluate all-cause mortality after successful EET.

Methods In the Netherlands, EET is centralized in 9 expert centers, with a standardized treatment/follow-up protocol. We included all patients with complete eradication (CE-BE) after EET from 2008-2018 (van Munster et al., Gut, 2021). Data were merged with Statistics Netherlands for survival outcomes. Vital follow-up: time between end of treatment and death or data collection. Primary outcome was annual incidence rate (AIR) for other-cause mortality after EET.

Results In total, 1,154 patients (mean age 64 (SD 9)) achieved CE-BE. During median 49 months of vital follow-up (IQR 26-72), 95/1154 patients (8%) died median 40 months(IQR 16-59) after EET. The AIR for all-cause mortality was 15.0 per 1000 person years [95%CI 12-18]. In total, 92/95 (97%) patients died of causes other than esophageal cancer (AIR unrelated mortality 14.5 per 1000 person-years [95%CI 11-18]). Most common causes of death: other cancer (n=35, 38%), cardiovascular disease (n=24, 26%) and pulmonary disease (n=13, 14%). Remaining 3/95 patients (3%) died of recurrent esophageal cancer (AIR 0.5 per 1000 person years [95%CI 0.4-0.5]), median 48 months(range 28-61) after EET.

Conclusions After successful EET, the risk of dying from causes other than EAC was 30 times higher than the risk of dying from recurrent EAC. The value of aggressive post-EET surveillance is likely overstated.

Publication History

Article published online:
14 April 2022