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Recurrence of esophageal intestinal metaplasia after treatment of Barrett's

This month's issue of Gastroenterology examines the recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett's esophagus.

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Radiofrequency ablation is an established treatment for dysplastic Barrett's esophagus.

Although short-term end points of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia after ablation.

Dr Milli Gupta and colleagues from Minnesota, USA estimated the incidence and identified factors that predicted the recurrence of  intestinal metaplasia  after successful radiofrequency ablation.

The researchers analyzed data from 592 patients with Barrett's esophagus treated with radiofrequency ablation from 2003 through 2011 at 3 tertiary referral centers.

The doctors defined complete remission of intestinal metaplasia as eradication of intestinal metaplasia, documented by 2 consecutive endoscopies.

Recurrence was defined as the presence of intestinal metaplasia or dysplasia after complete remission of intestinal metaplasia  in surveillance biopsies.

There were 2 experienced gastrointestinal pathologists that confirmed pathology findings.

The doctors noted that based on histology analysis, before radiofrequency ablation, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had nondysplastic Barrett's esophagus.

Of patients treated, 448 were assessed after radiofrequency ablation.

There were 55% of patients who underwent endoscopic mucosal resection before radiofrequency ablation.

22% of all recurrences observed were dysplastic Barrett's esophagus
Gastroenterology

The researchers found that the median time to complete remission of intestinal metaplasia  was 22 months, with 56% of patients in complete remission of intestinal metaplasia  by 24 months.

Increasing age and length of Barrett's esophagus segment were associated with longer times to complete remission of intestinal metaplasia.

The team noted that 24 months after complete remission of intestinal metaplasia, the incidence of recurrence was 33%.

The researchers found that 22% of all recurrences observed were dysplastic Barrett's esophagus.

The doctors noted that there were no demographic or endoscopic factors associated with recurrence.

Complications developed in 6.5% of subjects treated with radiofrequency ablation, and strictures were the most common complication.

Dr Gupta's team commented, "Of patients with Barrett's esophagus treated by radiofrequency ablation , 56% were in complete remission after 24 months."

"However, 33% of these patients had disease recurrence within the next 2 years."

"Most recurrences were nondysplastic and endoscopically manageable, but continued surveillance after Radiofrequency ablation is essential."

Gastroenterol 2013: 145(1): 79-86
12 July 2013

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