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Barrett’s Esophagus – Risk of Recurrence after Endoscopic Therapy
Barrett's esophagus (BE) is associated with an increased risk of developing esophageal cancer; currently, endoscopic eradication therapy (EET) is the main treatment to achieve complete remission of intestinal metaplasia (CRIM) – there is no endoscopic or histologic evidence of Barrett’s esophagus.
Mayo Clinic gastroenterologist, Dr. Prasad Iyer discusses a recently published study, which focuses on the outcomes of patients with BE who have been treated with endoscopic therapy, including endoscopic resection and ablation, and who’ve achieved CRIM.
The study examined important factors, such as
- What is the timeline of recurrence, following successful endoscopic therapy?
- Where does recurrence occur?
- Can the pattern of biopsies and intensity of surveillance be simplified?
Results of the study showed that
- There is a substantial risk of recurrence, which tends to increase progressively over time.
- Most of the recurrences tend to occur at the gastroesophageal (GE) junction – the lower part of the esophagus that connects to the stomach – and are invisible.
- When it occurs in the esophagus, most recurrence is visible – random biopsies don’t seem to pick up significant recurrences.
- Eighty five percent of recurrences in the esophagus occur in the distal 5 cms. even when the Barrett’s is longer than 5 cms.
According to Dr. Iyer, these findings suggest that
- The need for continued surveillance, even after remission, is imperative.
- Biopsy of the GE junction, during surveillance, is extremely important.
- For recurrences that occur in the esophagus, biopsies can be limited to the distal 5 cms.
- Since the yield of random biopsies is exceptionally low, additional studies with long-term follow-up are needed.
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