Detection of Intestinal Metaplasia After Successful Eradication of Barrett’s Esophagus with Radiofrequency Ablation

Abstract

Background Radiofrequency ablation (RFA) is an effective means of eradicating Barrett's esophagus (BE), both with and without associated dysplasia. Several studies have documented high initial success rates with RFA. However, there is limited data on IM detection rates after eradication. Aims To determine the rate of detection of intestinal metaplasia (IM) after successful eradication of Barrett's esophagus. Methods BE patients with and without dysplasia who had undergone RFA were retrospectively identified. Only those who had complete eradication as documented on the initial post-ablation endoscopy, and had minimum two surveillance endoscopies, were included in the analyses. Clinical, demographic, and endoscopic data were collected. Cumulative incidence of IM detection was calculated by the Kaplan–Meier method. Results Forty-seven patients underwent RFA and had complete eradication of Barrett's epithelium. The majority of patients were male (76.6%), and the mean age was 64.2 years. The cumulative incidence of newly detected IM at 1 year was 25.9% (95% CI 15.1–42.1%). Dysplasia was detected at the time of recurrence in four patients, and all cases were detected at the GE junction in the absence of visible BE. Patients with recurrent IM had longer baseline segments of BE (median, 4 cm vs. 2 cm, p = 0.03). Conclusions The rate of detection of new IM is high in patients who have undergone successful eradication of BE by RFA. Additionally, dysplasia can recur at the GE junction in the absence of visible BE. Future studies are warranted to identify those patients at increased risk for the development of recurrent intestinal metaplasia.

Molecular biomarkers and ablative therapies for Barrett’s esophagus

“…Importantly, these authors detected dysplasia at the time of recurrence in four patients. Despite the lack of direct biomarker evidence, these studies suggest that RFA may not eliminate the risk of progression to cancer in all patients [92], an outcome consistent with clinical data from a randomized trial of RFA ablation vs.…”

Diagnosis and management of Barrett’s metaplasia: What’s new

“…A major problem limiting the conclusions that can drawn from these reports is that they do not describe specifically how frequently biopsy specimens contained sufficient subepithelial lamina propria to be informative for buried metaplasia [63] . A different result was found by Vaccaro et al [64] who performed a retrospective analysis of patients with BE who underwent RFA. The cumulative incidence of newly detected intestinal metaplasia at 1 year was 25.9%.…”

Barrett's Esophagus: The American Perspective

“…In contrast, one recent study by Vaccaro et al [35 ]of 47 patients who had RFA with apparent complete eradication of intestinal metaplasia found recurrent metaplasia in 15 patients (32%) during a follow-up period ranging from 5 to 38 months. Follow-up endoscopic procedures in this study included taking four biopsy specimens from columnar epithelium at the gastroesophageal junction (GEJ) just distal to the neosquamocolumnar junction.…”

“…During surveillance colonoscopy, however, recurrent polyps are visible lesions that are removed immediately. After RFA for Barrett's esophagus, Vaccaro et al [35] showed that intestinal metaplasia can recur in almost one third of patients within 3 years and, in most cases, this recurrence is not visible and is detected only as the result of biopsy sampling at the GEJ. Does this mean that patients with recurrent metaplasia in those biopsy samples will require another endoscopy to administer more RFA, and perhaps another endoscopy after that to document that the recurrent metaplasia was eradicated?…”