Post-ablation surveillance in Barrett's esophagus: A review of the literature

Abstract

Barrett's esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett's mucosa is defined as harboring high grade dysplasia or intra-mucosal cancer, and carries a high risk of progression to esophageal adenocarcinoma. The rising incidence of Barrett's lesions along with the high morbidity of surgical approaches has led to the development of numerous validated endoscopic techniques capable of eradicating neoplastic mucosa in a minimally invasive manner. While there has been widespread adoption of these techniques, less is known about optimal surveillance intervals in the post-therapy period. This is due in part to limitations in current surveillance methods, questions about durability of treatment response and the risk of subendothelial progression. As we are now able to achieve organ sparing eradication of superficial neoplasia in BE, we need to also then focus our attention on how best to manage these patients after eradication is achieved. Implementing optimal surveillance practices requires additional understanding of the biology of the disease, appreciation of the limits of current tools and treatments, and exploration of the role of adjunctive technologies. The aim of this article is to provide a comprehensive review of current literature surrounding post-ablation surveillance in neoplastic BE.

Gastroesophageal Reflux Disease and Complications

“…Management of strictures requires mechanical dilation of the lumen along with acid suppressive therapy to prevent recurrence (Ravich 2017;Adler and Siddiqui 2017). Esophageal strictures can also occur in patients undergoing endoscopic management for esophageal varices, Barrett's esophagus, or early-stage esophageal adenocarcinoma (EAC) which usually involves tissue coagulation using bipolar cautery, sclerotherapy, band ligation, or radiofrequency ablation (Reilly et al 1984;Stier et al 2016).…”

The first experience in the use of a circular cylinder in Ukraine for endoscopic radiofrequency ablation at Barrett›s esophagus

“…Учитывая трудоёмкость и травматичность подобного исследования, его высокую стоимость, а также риски пропуска микроскопических диспластических изменений слизистой оболочки при эндоскопическом исследовании и при изучении микропрепаратов, особенно в случаях длинного сегмента ПБ, для снижения риска аденокарциномы пищевода ЭРЧА может применятся и у этой группы пациентов. Для чего могут использоваться секторальные и циркулярные датчики (90 и 360 градусов) [1][2][3][4][5][6].…”

Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

“…However, high recurrence rates have been reported, including up to 33% recurrence of intestinal metaplasia or dysplasia at 2 years in the case of RFA 12 . Residual disease, particularly at the GEJ, and the existence of disease buried beneath neosquamous epithelium are also sources of concern 13 - 17 …”