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What We Have to Do After the Treatment of Metaplasia or Dysplasia in Barrett’s Esophagus? Protocols and Timing of Follow-Up in the Treated Patient

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Revisiting Barrett's Esophagus
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Abstract

Malignant degeneration of Barrett’s esophagus occurs from non-dysplastic to adenocarcinoma. For this reason, guidelines recommend regular endoscopic surveillance and control acid exposure of Barrett’s. Endoscopic therapies are recommended for dysplastic Barrett’s eradication when present. After eradication of Barrett’s, we must consider endoscopic surveillance. The follow-up protocol depends on what were the worst status of Barrett’s before endoscopic treatment.

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References

  1. Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.

    Article  CAS  Google Scholar 

  2. Weusten B, Bisschops R, Coron E, Dinis-Ribeiro M, Dumonceau JM, Esteban JM, Hassan C, Pech O, Repici A, Bergman J, di Pietro M. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49(2):191–8. https://doi.org/10.1055/s-0042-122140.

    Article  PubMed  Google Scholar 

  3. Cassani L, Slaughter JC, Yachimski P. Adherence to therapy for Barrett’s esophagus-associated neoplasia. United European Gastroenterol J. 2016;4(1):42–8.

    Article  CAS  Google Scholar 

  4. Moss A, Bourke MJ, Hourigan LF, et al. Endoscopic resection for Barrett’s high-grade dysplasia and early esophageal adenocarcinoma: an essential staging procedure with long-term therapeutic benefit. Am J Gastroenterol. 2010;105:1276–83.

    Article  Google Scholar 

  5. American Gastroenterological Association, Spechler SJ, Sharma P, et al. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–91.

    Article  Google Scholar 

  6. May A, Gossner L, Pech O, et al. Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach. Eur J Gastroenterol Hepatol. 2002;14:1085–91.

    Article  Google Scholar 

  7. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.

    Article  CAS  Google Scholar 

  8. Shaheen NJ, Overholt BF, Sampliner RE, Wolfsen HC, Wang KK, Fleischer DE, Sharma VK, Eisen GM, Fennerty MB, Hunter JG, Bronner MP, Goldblum JR, Bennett AE, Mashimo H, Rothstein RI, Gordon SR, Edmundowicz SA, Madanick RD, Peery AF, Muthusamy VR, Chang KJ, Kimmey MB, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Dumot JA, Falk GW, Galanko JA, Jobe BA, Hawes RH, Hoffman BJ, Sharma P, Chak A, Lightdale CJ. Durability of radiofrequency ablation in Barrett’s esophagus with dysplasia. Gastroenterology. 2011;141:460–8. https://doi.org/10.1053/j.gastro.2011.04.061.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Orman ES, Kim HP, Bulsiewicz WJ, Cotton CC, Dellon ES, Spacek MB, Chen X, Madanick RD, Pasricha S, Shaheen NJ. Intestinal metaplasia recurs infrequently in patients successfully treated for Barrett’s esophagus with radiofrequency ablation. Am J Gastroenterol. 2013;108:187–95; quiz 196. https://doi.org/10.1038/ajg.2012.413.

    Article  PubMed  Google Scholar 

  10. Phoa KN, Pouw RE, van Vilsteren FG, Sondermeijer CM, Ten Kate FJ, Visser M, Meijer SL, van Berge Henegouwen MI, Weusten BL, Schoon EJ, Mallant-Hent RC, Bergman JJ. Remission of Barrett’s esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology. 2013;145:96–104. https://doi.org/10.1053/j.gastro.2013.03.046.

    Article  PubMed  Google Scholar 

  11. Pouw RE, Wirths K, Eisendrath P, Sondermeijer CM, Ten Kate FJ, Fockens P, Devière J, Neuhaus H, Bergman JJ. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol. 2010;8:23–9. https://doi.org/10.1016/j.cgh.2009.07.003.

    Article  PubMed  Google Scholar 

  12. Gupta M, Iyer PG, Lutzke L, Gorospe EC, Abrams JA, Falk GW, Ginsberg GG, Rustgi AK, Lightdale CJ, Wang TC, Fudman DI, Poneros JM, Wang KK. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US Multicenter Consortium. Gastroenterology. 2013;145:79–86.e1. https://doi.org/10.1053/j.gastro.2013.03.008.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, Fullarton G, Di Pietro M, Ravi N, Visser M, Offerhaus GJ, Seldenrijk CA, Meijer SL, ten Kate FJ, Tijssen JG, Bergman JJ. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311:1209–17. https://doi.org/10.1001/jama.2014.2511.

    Article  CAS  PubMed  Google Scholar 

  14. Krishnan K, Pandolfino JE, Kahrilas PJ, et al. Increased risk for persistent intestinal metaplasia in patients with Barrett’s esophagus and uncontrolled reflux exposure before radiofrequency ablation. Gastroenterology. 2012;143:576–81.

    Article  Google Scholar 

  15. Korst RJ, Santana-Joseph S, Rutledge JR, et al. Effect of hiatal hernia size and columnar segment length on the success of radiofrequency ablation for Barrett’s esophagus: a single-center, phase II clinical trial. J Thorac Cardiovasc Surg. 2011;142:1168–73.

    Article  Google Scholar 

  16. Inadomi JM. Time to burn? Endoscopic ablation for Barrett’s esophagus. Gastroenterology. 2011;141:417–9.

    Article  Google Scholar 

  17. Wolf WA, Pasricha S, Cotton C, et al. Incidence of esophageal adenocarcinoma and causes of mortality after radiofrequency ablation of Barrett’s esophagus. Gastroenterology. 2015;149:1752–61.

    Article  Google Scholar 

  18. Cotton CC, Sampliner RE, et al. Late recurrence of Barrett’s esophagus after complete eradication of intestinal metaplasia is rare: final report from ablation in intestinal metaplasia containing dysplasia trial. Gastroenterology. 2017;153(3):681–8.

    Article  Google Scholar 

  19. Stier HW, Konda VJ, Hart J, Waxman I. Post-ablation surveillance in Barrett’s esophagus: a review of the literature. World J Gastroenterol. 2016;22(17):4297–306.

    Article  Google Scholar 

  20. Pouw RE, Visser M, Odze RD, Sondermeijer CM, ten Kate FJ, Weusten BL, Bergman JJ. Pseudo-buried Barrett’s post radiofrequency ablation for Barrett’s esophagus, with or without prior endoscopic resection. Endoscopy. 2014;46:105–9.

    Article  Google Scholar 

  21. Odze RD, Lauwers GY. Histopathology of Barrett’s esophagus after ablation and endoscopic mucosal resection therapy. Endoscopy. 2008;40:1008–15.

    Article  CAS  Google Scholar 

  22. Bedi AO, Kwon RS, Rubenstein JH, et al. A survey of expert follow-up practices after successful endoscopic eradication therapy for Barrett’s esophagus with high-grade dysplasia and intramucosal adenocarcinoma. Gastrointest Endosc. 2013;78(5):696–701. https://doi.org/10.1016/j.gie.2013.04.196.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology (BSG) guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.

    Article  Google Scholar 

  24. Koop H, Fuchs KH, Labenz J, et al. S2k guideline: gastroesophageal reflux disease guided by the German Society of Gastroenterology AWMF register no. 021-013. Z Gastroenterol. 2014;52:1299–346.

    Article  Google Scholar 

  25. Evans JA, Early DS, Fukami N, et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76(6):1087–94.

    Article  Google Scholar 

  26. Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation of Barrett’s esophagus: a systematic review. Am J Gastroenterol. 2011;106:1899–908; quiz 1909. https://doi.org/10.1038/ajg.2011.255.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Corley DA. Can you stop surveillance after radiofrequency ablation of Barrett’s esophagus? A glass half full. Gastroenterology. 2013;145:39–42. https://doi.org/10.1053/j.gastro.2013.05.039.

    Article  PubMed  Google Scholar 

  28. Gorospe EC, Sun G, Wang KK. Endpoints for radiofrequency ablation in Barrett’s dysplasia. Am J Gastroenterol. 2013;108:197–9. https://doi.org/10.1038/ajg.2012.415.

    Article  PubMed  Google Scholar 

  29. Titi M, Overhiser A, Ulusarac O, Falk GW, Chak A, Wang K, Sharma P. Development of subsquamous high-grade dysplasia and adenocarcinoma after successful radiofrequency ablation of Barrett’s esophagus. Gastroenterology. 2012;143:564–566.e1. https://doi.org/10.1053/j.gastro.2012.04.051.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Chennat J, Ross AS, Konda VJ, Lin S, Noffsinger A, Hart J, Waxman I. Advanced pathology under squamous epithelium on initial EMR specimens in patients with Barrett’s esophagus and high-grade dysplasia or intramucosal carcinoma: implications for surveillance and endotherapy management. Gastrointest Endosc. 2009;70:417–21. https://doi.org/10.1016/j.gie.2009.01.047.

    Article  PubMed  Google Scholar 

  31. Zeki SS, Haidry R, Graham TA, Rodriguez-Justo M, Novelli M, Hoare J, Dunn J, Wright NA, Lovat LB, McDonald SA. Clonal selection and persistence in dysplastic Barrett’s esophagus and intramucosal cancers after failed radiofrequency ablation. Am J Gastroenterol. 2013;108:1584–92. https://doi.org/10.1038/ajg.2013.238.

    Article  PubMed  Google Scholar 

  32. Wu J, Pan YM, Wang TT, Gao DJ, Hu B. Endotherapy versus surgery for early neoplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc. 2014;79:233–241.e2. https://doi.org/10.1016/j.gie.2013.08.005.

    Article  PubMed  Google Scholar 

  33. Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology. 2012;143:336–46. https://doi.org/10.1053/j.gastro.2012.04.032.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hinojosa-Lindsey M, Arney J, Heberlig S, Kramer JR, Street RL, El-Serag HB, Naik AD. Patients’ intuitive judgments about surveillance endoscopy in Barrett’s esophagus: a review and application to models of decision-making. Dis Esophagus. 2013;26:682–9. https://doi.org/10.1111/dote.12028.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Vaccaro BJ, Gonzalez S, Poneros JM, Stevens PD, Capiak KM, Lightdale CJ, Abrams JA. Detection of intestinal metaplasia after successful eradication of Barrett’s esophagus with radiofrequency ablation. Dig Dis Sci. 2011;56:1996–2000. https://doi.org/10.1007/s10620-011-1680-4.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Inadomi JM, Somsouk M, Madanick RD, Thomas JP, Shaheen NJ. A cost-utility analysis of ablative therapy for Barrett’s esophagus. Gastroenterology. 2009;136:2101–2114.e1-6. https://doi.org/10.1053/j.gastro.2009.02.062.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Alvarez Herrero L, Curvers WL, Bisschops R, Kara MA, Schoon EJ, ten Kate FJ, Visser M, Weusten BL, Bergman JJ. Narrow band imaging does not reliably predict residual intestinal metaplasia after radiofrequency ablation at the neo-squamo columnar junction. Endoscopy. 2014;46:98–104. https://doi.org/10.1055/s-0033-1344986.

    Article  PubMed  Google Scholar 

  38. Vakoc BJ, Shishko M, Yun SH, et al. Comprehensive esophageal microscopy by using optical frequency-domain imaging (with video). Gastrointest Endosc. 2007;65:898–905.

    Article  Google Scholar 

  39. Benjamin T, Shakya S, Thota PN. Feasibility of volumetric laser endomicroscopy in Barrett’s esophagus with dysplasia and in post-ablation surveillance. J Gastrointestin Liver Dis. 2016;25(3):407–8.

    PubMed  Google Scholar 

  40. Trindade AJ, George BJ, Berkowitz J, Sejpal DV, Mckinley MJ. Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett’s esophagus. Endosc Int Open. 2016;4:E318–22. https://doi.org/10.1055/s-0042-101409.

    Article  PubMed  PubMed Central  Google Scholar 

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Esteban, JM. (2019). What We Have to Do After the Treatment of Metaplasia or Dysplasia in Barrett’s Esophagus? Protocols and Timing of Follow-Up in the Treated Patient. In: Galloro, G. (eds) Revisiting Barrett's Esophagus. Springer, Cham. https://doi.org/10.1007/978-3-319-92093-1_17

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  • DOI: https://doi.org/10.1007/978-3-319-92093-1_17

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