Buried Barrett's metaplasia eradicated after radiofrequency ablation

This month's issue of Endoscopy examines the prevalence of buried Barrett's metaplasia before and after radiofrequency ablation.

Radiofrequency ablation to treat Barrett's esophagus is increasingly accepted.

Description of the etiology, natural history, and prevalence of buried Barrett's metaplasia following radiofrequency ablation is limited, although buried Barrett's metaplasia continues to pose a clinical dilemma.

Dr Yuan and colleagues assessed the prevalence, characteristics, and eradication rate of Barrett's metaplasia in patients with both dysplastic and nondysplastic Barrett's esophagus, treated with radiofrequency ablation and followed over time.

The presence of Barrett's esophagus, dysplasia, and buried Barrett's metaplasia, before and after radiofrequency ablation, was assessed by 2 gastrointestinal pathologists in a retrospective chart review of patients who had undergone radiofrequency ablation, and had completed appropriate follow-up.

The researchers identified 112 patients with completed treatment, and no further planned radiofrequency ablation.

Buried Barrett's metplasia was found in 71% during the radiofrequency ablation treatment

Endoscopy

In 108, no residual Barrett's esophagus was seen after radiofrequency ablation, and 4 patients with persistent Barrett's tissue underwent surgery.

Regarding Barrett's metaplasia, 15% of patients had evidence of buried Barrett's metaplasia during evaluation.

The team found buried Barrett's metplasia in 71% of patients during the radiofrequency ablation treatment.

The research team found that 8 patients had previously undergone non-radiofrequency ablation therapy and radiofrequency ablation for Barrett's esophagus, and 4 having no previous intervention.

In 29%, Barrett's metaplasia was seen only after radiofrequency ablation monotherapy.

The researchers observed that all 17 showed no evidence of buried Barrett's metaplasia at final evaluation, and were classified in the complete remission group.

Dr Yuan's team concluded, "Both Barrett's esophagus and buried Barrett's metaplasia were completely eradicated in all patients with long-term follow-up after radiofrequency ablation."

"Almost half of the patients with buried Barrett's metaplasia had a prior history of non-radiofrequency ablation therapy for Barrett's esophagus compared with 26% the non-Barrett's metaplasia cohort."

"All patients with previously identified Barrett's esophagus, and buried Barrett's metaplasia were completely cleared of disease at final follow-up."