Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

Abstract

Patients undergoing foregut surgeries can have de novo findings or worsening of underlying upper gastrointestinal pathologies including Barrett’s esophagus and gastric intestinal metaplasia. These changes carry a potentially increased risk for malignancy development in the future raising the question of the utility of post-operative surveillance endoscopy after esophagectomy, bariatric and metabolic surgeries (Sleeve gastrectomy and Roux-en-Y Gastric Bypass), achalasia treatment, and anti-reflux surgery. In this narrative review, we conduct a literature exploration of available data on post-operative endoscopic surveillance findings following the procedures summarizing the prevalence of upper gastrointestinal pathologies and recommendations on the utility of postoperative endoscopy from established medical societies.

The Future of Strategies to Reduce Mortality From Esophageal Adenocarcinoma

“…Surveillance endoscopy among individuals with Barrett's esophagus to identify those who would benefit from endoscopic or surgical treatment continues to be based on a failed premise; specifically, limiting screening to individuals with symptomatic reflux, while enriching the sample for Barrett's esophagus, excludes a large proportion of individuals who develop esophageal adenocarcinoma. 1 Current guidelines from many gastroenterology societies recommend endoscopy every 3 to 5 years using high-resolution white-light plus enhanced imaging (chromoendoscopy) to obtain targeted biopsies from any mucosal abnormalities in addition to random 4-quadrant biopsies taken every 1 to 2 cm along the length of Barrett's esophagus. 2 Several facts minimize the effectiveness of this strategy: screening is performed in a minority of eligible individuals 3 ; screening fails to detect the majority of individuals who develop esophageal adenocarcinoma 4 ; adherence to the recommended biopsy protocol is poor 5 ; there is discordance between pathologist's interpretation of histopathology 6 ; and individuals at high risk of esophageal adenocarcinoma also have high mortality from other diseases.…”

Can We Impact the Incidence and Outcomes of Barrett’s Esophagus and Esophageal Adenocarcinoma?

“…8,9 This issue also contains fantastic complementary articles on screening for foregut cancers in Lynch syndrome and surveillance after surgery. 10,11 We are pleased to publish 4 original research articles this month and 1 original review as our journal continues to grow. Dr. Poggi et al share their experience with pre procedure diagnostic testing in a large cohort of bariatric surgery patient.…”