Recurrent Barrett’s esophagus-related neoplasia is uncommon after successful endoscopic eradication therapy over long-term follow-up

US-based data describing long-term outcomes following successful endoscopic eradication therapy (EET) for Barrett's esophagus (BE) is limited. We assessed the incidence of recurrent BE and BE-related neoplasia and factors associated with recurrent BE in a prospective cohort with long-term follow-up. Patients who underwent EET at four tertiary-care centers from 2013 to 2019 and achieved complete eradication of intestinal metaplasia (CEIM) with ≥5 years of follow-up after CEIM were included. Time-to-event analyses were performed to determine the incidence rate (IR) of recurrent BE and BE-related neoplasia, and a Cox proportional hazards regression model was used to identify factors associated with recurrent BE. Change-point analysis estimated the time at which the rate of recurrent BE changes. A total of 152 patients with a median follow-up of 81.0 months (range 60-155 months) after CEIM were included. Recurrent BE occurred in 57 patients, including 43 (28.3%) with recurrent IM and 14 (9.2%) with BE-related neoplasia. The IR of recurrent BE and recurrent BE-related neoplasia were 6.8 (95% confidence interval [CI] 5.1, 8.8) and 1.3 (95% CI 0.7, 2.2) per 100 person-years, respectively. Baseline histology of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) was the strongest predictor of recurrent BE (hazard ratio 4.4, 95% CI 2.1, 9.0). Recurrent BE peaked at 14 months after CEIM and remained stable thereafter. The IR of recurrent BE-related neoplasia after CEIM is low. The rate of recurrent BE decreases at 14 months and remains stable thereafter and baseline histology of HGD/EAC is the strongest predictor of recurrent BE. These results have implications for guiding endoscopic surveillance. ClinicalTrials.gov ID: NCT02634645.