Endoscopic eradication therapy (EET) with radiofrequency ablation ± endoscopic resection, is recommended for treatment of Barrett’s esophagus (BE) with dysplasia/early cancer (1). After successful EET, guidelines recommend endoscopic follow-up (FU) of 5 years for baseline low-grade dysplasia (LGD), and 10 years for baseline high-grade dysplasia (HGD)/T1 cancer (1). We present the long-term outcomes of our previously published, nationwide cohort of BE patients, successfully treated with EET between 2008-2018 in a centralized setting in BE expert centers (BEC) in the Netherlands (2). Care for patients was provided according to a uniform protocol and by expert endoscopists and pathologists.

All patients who underwent successful EET for BE with dysplasia/T1 cancer were included. Successful EET was defined as complete eradication of BE and of dysplasia/cancer. FU data was collected up to September 2025. Endoscopic FU was defined as time from last treatment until last FU endoscopy. Vital FU was defined as time from last treatment until recurrence, data collection of vital status, or death. The primary outcome was recurrent dysplasia or cancer. Recurrences were classified as LGD in random biopsies from a normal appearing gastroesophageal junction (GEJ), dysplasia/cancer in recurrent BE eligible for endoscopic treatment, or advanced a/o metastasized cancer ineligible for endoscopic treatment.

We included 1269 patients (1038 male, median age 66 yrs, median BE of C2M4) with baseline LGD in 27%, and HGD/cancer in 73%. Median endoscopic FU was 65 months (IQR 42-93) with a median of 5 endoscopies (IQR 3-7). FU endoscopies were already discontinued in 58% after median 101 months (IQR 74-138), due to: guideline recommendation to stop (20%), limited life expectancy (18%), or death (14%).

Recurrent LGD/HGD/cancer was detected in 91/1269 (7%; annual risk 1.3%) after a median of 35 months (IQR 23-55) and 3 endoscopies (IQR 2-5). Recurrence of HGD/cancer was detected in 4.2% (annual risk 0.8%). The total number of endoscopies to find one recurrence was 73. In total, 9/91 recurrences were diagnosed after the guideline-recommended time point at which FU can be discontinued. Overall, 84% of recurrences was amenable for curative endoscopic re-treatment, while 16% (1% of the overall cohort) was detected as advanced cancer. In total, 11/1269 patients (0.9%) had cancer-related death. In contrast, during a median vital follow-up of 101 months (IQR 80-136), 318 patients (25%) had unrelated death.

In patients with baseline LGD, recurrent LGD/HGD/cancer was detected in 19/347 patients (5%; annual risk 0.7%). The majority of recurrences was amenable for curative endoscopic treatment (16/19; 84%), consisting of recurrent LGD in a normal appearing GEJ in 5/347 (1.0%, annual risk 0.2%) or dysplasia/cancer in recurrent BE in 11/347 (3%, annual risk 0.4%). The remaining 3/19 patients developed advanced a/o metastasized cancer (1%, annual risk 0.1%), after a median 85 months (IQR n.a.) after treatment. The majority (17/19; 89%) of recurrences were found during routine FU-endoscopy. The remaining 2/19 (11%) were detected in patients presenting with symptoms, including one after endoscopic FU had been stopped.

In patients with baseline HGD/cancer, recurrent LGD/HGD/cancer was found in 72/922 patients (8%; annual risk 1.0%). Overall, 60/72 (83%) had recurrence amenable for curative endoscopic treatment, consisting of recurrent LGD in a normal appearing GEJ in 13/922 (1%, annual risk 0.2%) or dysplasia/cancer in recurrent BE in 47/922 (5%, annual risk 0.6%). The remaining 12/72 patients (17%) had recurrence of advanced a/o metastasized cancer (1%, annual risk 0.2%) after a median FU of 34 months (IQR 17-90). Most (65/72; 90%) recurrences were found during routine FU-endoscopy. In 7/72 (10%) recurrence was detected in patients presenting with symptoms, including one after endoscopic FU had been stopped.

Successful EET in an expert treatment setting, yields a long-term durable effect, demonstrating low recurrence risks in both baseline LGD and HGD/cancer patients, and <1% cancer related death after median vital FU of 101 months. The risk of developing symptomatic cancer recurrence after guideline advised cessation of FU is extremely low.