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Am J Gastroenterol. 2020 Jan 3. doi: 10.14309/ajg.0000000000000514. [Epub ahead of print]

Approach to the Post-Ablation Barrett's Esophagus Patient.

Author information

1
Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
2
Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.
3
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Abstract

Because of the rising incidence and lethality of esophageal adenocarcinoma, Barrett's esophagus (BE) is an increasingly important premalignant target for cancer prevention. BE-associated neoplasia can be safely and effectively treated with endoscopic eradication therapy (EET), incorporating tissue resection and ablation. Because EET has proliferated, managing patients after complete eradication of intestinal metaplasia has taken on increasing importance. Recurrence after complete eradication of intestinal metaplasia occurs in 8%-10% of the patients yearly, and the incidence may remain constant over time. Most recurrences occur at the gastroesophageal junction, whereas those in the tubular esophagus are endoscopically visible and distally located. A simplified biopsy protocol limited to the distal aspect of the BE segment, in addition to gastroesophageal junction sampling, may enhance efficiency and cost without significantly reducing recurrence detection. Similarly, research suggests that current surveillance intervals may be excessively frequent, failing to reflect the cancer risk reduction of EET. If validated, longer surveillance intervals could reduce the burden of resource-intensive endoscopic surveillance. Several important questions in post-EET management remain unanswered, including surveillance duration, the significance of gastric cardia intestinal metaplasia, and the role of advanced imaging and nonendoscopic sampling techniques in detecting recurrence. These merit further research to enhance quality of care and promote a more evidence-based approach.

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