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‘Big Brother is watching’ but Barrett’s surveillance is easier to swallow…
Radiofrequency ablation (RFA) is key in the therapy of early neoplasia in Barrett’s oesophagus (BO). However, a small proportion of patients experience neoplastic recurrence (NR) after complete eradication of intestinal metaplasia (CEIM). While the safety and efficacy of RFA in achieving CEIM are robust, post-treatment surveillance strategies lack a strong evidence base.
Cotton et al1 address this issue by analysing a registry of 3105 patients undergoing RFA for BO in the USA and 373 in the UK to construct models predicting the risk of NR after CEIM.
Incidence of NR was associated with the most severe pre-RFA histological grade, age, sex, BO length and mucosal resection. Using most severe histological grade was the best performing risk prediction model in determining NR, with a C statistics score of 0.892 in the US cohort, validated in the UK cohort. For patients with low-grade dysplasia (NR rate 2%), surveillance endoscopy at 1 and 3 years after CEIM is proposed. For high-grade dysplasia or intramucosal cancer (NR rate 5.3%), surveillance at 3 and 6 months, 1 year then annually is suggested.
This study …
Contributors PDJD and APM contributed equally to the review of the literature and composition of the paper. All authors planned the paper. IDP is the supervising author and guarantor.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Correction notice This article has been corrected since it published Online First. The first author’s name has been corrected.
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