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Model predicts recurrence after eradication of early Barrett’s neoplasia

Reuters Health - 01/04/2022  -A new model that predicts recurrence after endoscopic eradication of Barrett's esophagus (BE) with dysplasia or early cancer can help establish a personalized follow-up strategy for patients, researchers say. 

The model, which has been externally validated, is available at https://barrett-recurrence.shinyapps.io/Barrett. 

"Once complete Barrett's eradication is achieved, the chances for neoplastic recurrence are so small that we significantly reduce the burden of endoscopic follow-up procedures in the vast majority of cases," Dr. Jacques J.G.H.M. Bergman of Amsterdam University Medical Center told Reuters Health by email. "Those with an increased risk can be identified with our prediction model." 

Clinicians can start implementing the model now, he said, to "reduce the burden of healthcare and unnecessary worries (for) our patients." Guidelines should incorporate the model, he added, "to ensure the quality of the actual endoscopic eradication by centralizing care in high-volume expert centers, and then allowing the currently too-strict follow-up regimen only for the small subset of cases who have a significant recurrence risk." 

As reported in Gastroenterology, Dr. Bergman and colleagues built the model using data from the Dutch Barrett Expert Center Registry, which captures outcomes from all BE patients undergoing endoscopic treatment in the Netherlands. Input included predictors related to demographics, severity of reflux, histologic status at baseline, and treatment characteristics. 

The model was validated externally in BE patients treated in Switzerland and Belgium. 

A total of 1,154 patients with complete BE eradication were included for model building. During a mean endoscopic follow-up of four years, 38 patients developed recurrent disease (0.8%/person year). 

Characteristics independently associated with recurrence (strongest to weakest predictor) were a new visible lesion during the treatment phase; a higher number of emergency department treatments; male gender; increasing BE length; high-grade dysplasia or cancer at baseline; and younger age. 

External validation showed good calibration. 

Dr. Bergman noted, "Research is needed to improve the quality of endoscopic training in Barrett's eradication therapy. Now we are using too frequent endoscopic follow-up to compensate for suboptimal imaging, selection and treatment." 

Dr. Brooks Cash, Chief of Gastroenterology, Hepatology, and Nutrition at Memorial Hermann-Texas Medical Center and UTHealth in Houston commented on the study in an email to Reuters Health. "This seems like an extremely feasible approach...from recognized experts in the field. The fact that the investigators validated their tool in two other large, external databases and found similar results is encouraging." 

However, he said, "While this does appear to contribute meaningfully to risk assessment and likely will allow us to counsel our patients better, it would be nice if it were validated on a US cohort. Additionally, while we can speak to patients in relatively general terms with regards to their risk of neoplasia recurrence after ablation, the current study does not determine when we should be doing our surveillance examinations nor if there are any post-ablation steps that could be taken to lower the recurrence risk." 

Nonetheless, he added, "These investigators have developed an accessible and easy-to-use tool with information I have readily at hand. This will help me counsel and care for my patients more effectively and impress upon (them) that post-ablation aftercare is important and that their disease can come back." 

SOURCE: https://bit.ly/385SDDR  Gastroenterology, online March 16, 2022. 

By Marilynn Larkin 

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