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Natural History of the Post-ablation Esophagus

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Abstract

Endoscopic ablative therapy including radiofrequency ablation (RFA) represents the preferred management strategy for dysplastic Barrett’s esophagus (BE) and appears to diminish the risk of developing esophageal adenocarcinoma (EAC). Limited data describe the natural history of the post-ablation esophagus. Recent findings demonstrate that recurrent intestinal metaplasia (IM) following RFA is relatively frequent. However, dysplastic BE and EAC subsequent to the complete eradication of intestinal metaplasia (CEIM) are uncommon. Moreover, data suggest that the risk of recurrent disease is probably highest in the first year following CEIM. Recurrent IM and dysplasia are usually successfully eradicated with repeat RFA. Future studies may refine surveillance intervals and inform the length of time surveillance should be conducted following RFA with CEIM. Further data will also be necessary to understand the utility of chemopreventive strategies, including NSAIDs, in reducing the risk of recurrent disease.

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Abbreviations

IM:

Intestinal metaplasia

BE:

Barrett’s esophagus

GERD:

Gastroesophageal reflux disease

EAC:

Esophageal adenocarcinoma

LGD:

Low-grade dysplasia

HGD:

High-grade dysplasia

IMC:

Intramucosal carcinoma

RFA:

Radiofrequency ablation

CEIM:

Complete eradication of intestinal metaplasia

CED:

Complete eradication of dysplasia

BETRNet:

Barrett’s Esophagus Translational Research Network

VLE:

Volumetric laser endomicroscopy

WATS:

Wide-area transepithelial sampling

NSAID:

Non-steroidal anti-inflammatory drug

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Funding

This research was supported by NIH Award T32DK007634 (CCR) and NIH Award K24DK100548 (NJS).

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Authors and Affiliations

  1. Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Craig C. Reed & Nicholas J. Shaheen

  2. University of North Carolina School of Medicine, CB#7080, Chapel Hill, NC, 27599-7080, USA

    Nicholas J. Shaheen

  3. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA

    Craig C. Reed

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  1. Craig C. Reed
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  2. Nicholas J. Shaheen
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Reed: manuscript drafting; revision. Shaheen: supervision; manuscript drafting; revision.

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Correspondence to Nicholas J. Shaheen.

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Conflict of interest

None of the authors report any potential conflicts of interests with this study. Dr. Shaheen receives research funding from Medtronic, CSA Medical, Interpace Diagnostics, and CDx Medical.

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Reed, C.C., Shaheen, N.J. Natural History of the Post-ablation Esophagus. Dig Dis Sci 63, 2136–2145 (2018). https://doi.org/10.1007/s10620-018-5066-8

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