1070 – When Should We Look for Recurrence Following Complete Eradication of Intestinal Metaplasia (CE-IM)? Results from the Treatment with Resection and Endoscopic Ablation Techniques for Barrett's Esophagus (Treat-Be) Consortium

Background: There are limited data describing the durability of CE-IM in BE pts undergoing endoscopic eradication therapy (EET).Variable rates of recurrence have been described; some suggesting a relatively constant rate of recurrence while others a front-loaded risk.Aims: To assess the rate of recurrence of IM and dysplasia in BE patients achieving CE-IM and To describe recurrence histology and outcomes after recurrence Methods: This is a multicenter prospective study that enrolled BE pts undergoing EET at 4 centers.Demographics, endoscopic findings, and histology at treatment onset were noted.Details regarding EET (EET modalities, CE-IM rates) and findings of surveillance were noted.CE-IM was defined as absence of IM on surveillance biopsies from squamocolumnar junction and neosquamous epithelium; recurrence by presence of IM or dysplasia on surveillance biopsies after CE-IM.Only pts achieving CE-IM were included.Duration of f/u was calculated from CE-IM to most recent endoscopy.Kaplan-Meier (KM) curves with 95% CI for any recurrence after CE-IM were generated and incidence rates (IR) of recurrence based on baseline histology were compared using Wilcoxon Rank-Sum test.Results: 1178 pts were enrolled of which 807 (68.5%) met inclusion criteria (mean age 65.2 yrs, 79% males, 87% Whites, mean BE length 3.9 cm).Baseline histology was: non-dysplastic BE (5.7%), low-grade dysplasia (LGD, 34.9%), high-grade dysplasia (HGD, 32.5%) and intramucosal cancer (IMC, 26.1%).Overall 98% were treated with EMR/RFA (alone or in combination) for a mean of 2.6 (SD 1.3) sessions to achieve CE-IM.During a f/u period of 2317 person-yrs (PY) (mean f/u of 2.9 yrs/pt, SD 2.7), recurrence of IM was noted in 121 (15%), for an IR of 5.2/100 PY.Recurrence of dysplasia occurred in 36 (4.5%) for an IR of 1.6/100 PY.Mean time to recurrence was 1.8 (SD 1.5) yrs at a mean of 2.9 (SD 1.8) surveillance endoscopies.KM estimates of cumulative IR with 95% CIs for any recurrence are shown in Table .Additionally, KM estimates of overall recurrence and stratified by baseline histology (LGD vs. HGD/IMC) were consistent with a constant rate of recurrence over time (Figure).Baseline HGD/IMC pts had higher recurrence rates (rate ratio 2.22, 95% CI 1.51-3.26)compared to baseline LGD pts.All recurrences were the same or lower histological grade.Second CE-IM was achieved in 118 (97.5%) pts; none progressed to invasive cancer or required surgery.Conclusions: In this large cohort, the rate of recurrence (overall and stratified by histology) after CE-IM was low and constant throughout surveillance.This suggests that evenly spaced surveillance intervals should yield the same rate of recurrence, unlike the currently recommended intervals.Recurrent BE was never of a more severe histology than the baseline histology prior to EET.