Patterns of recurrent and persistent intestinal metaplasia after successful radiofrequency ablation of Barrett's esophagus

Robert J. Korst, Sobeida Santana-Joseph, John R. Rutledge, Arthur Antler, Vivian Bethala, Anthony Delillo, Donald Kutner, Benjamin E. Lee, Haleh Pazwash, Robert H. Pittman, Michael Rahmin, Mitchell Rubinoff

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Objective: Radiofrequency ablation can eradicate Barrett's esophagus successfully in the majority of cases. We sought to determine (1) how often intestinal metaplasia is detected during follow-up endoscopy after successful ablation and (2) patterns of persistent/recurrent intestinal metaplasia. Methods: Patients ablated successfully during a phase II clinical trial of radiofrequency ablation for Barrett's esophagus were followed using endoscopic surveillance according to a defined protocol. Systematic biopsies were performed in all patients throughout the neosquamous epithelium as well as at the gastroesophageal junction, and patterns of recurrent or persistent intestinal metaplasia were documented. Results: Fifty-three patients were ablated successfully during this single-institution clinical trial. A total of 151 follow-up endoscopies were performed (range, 1-5 endoscopies per patient) and 2492 biopsies were obtained, of which 604 (24%) were from the gastroesophageal junction. The median follow-up period was 18 months (range, 3-50 months). Recurrent/persistent intestinal metaplasia was detected in 14 patients (26%) in 3 distinct patterns: endoscopically invisible intestinal metaplasia underneath the neosquamous epithelium (buried glands) in 3 patients, visible recurrence in the tubular esophagus in 3 patients, and intestinal metaplasia of the gastroesophageal junction (with a squamous-lined tubular esophagus) in 10 patients. Dysplasia or cancer was not detected in any patient during the follow-up period. Conclusions: Recurrent/persistent intestinal metaplasia after successful radiofrequency ablation of Barrett's esophagus is relatively common. This finding has implications for the continued surveillance of patients who are ablated successfully.

Original languageEnglish
Pages (from-to)1529-1534
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number6
DOIs
StatePublished - Jun 2013
Externally publishedYes

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