Recurrence of Intestinal Metaplasia in the Cardia After Barrett’s Endoscopic Therapy: What To Do?
Prateek Sharma, MD, FASGE reviewing Solfisburg QS, et al. Gastrointest Endosc 2020 Oct 31.
In patients undergoing Barrett’s endoscopic therapy (BET), complete eradication of intestinal metaplasia (CE-IM) is the final goal. However, studies have reported recurrence of IM, specifically in the cardia/gastroesophageal junction (GEJ), even after CE-IM has been achieved. It is not clear whether cardia IM detected after BET should be treated endoscopically. Using a retrospective cohort from 3 centers, the authors of this study evaluated the risk of subsequent dysplasia (either in the esophagus or cardia) in patients who had recurrences of IM after BET and the benefit of treating this entity.
A total of 633 patients who achieved CE-IM after BET (mean age, 64 years; 85% men; mean BE length, 3 cm; 81% with baseline high-grade dysplasia [HGD]/esophageal adenocarcinoma [EAC]) were included in the analysis and followed for a mean duration of 47 months (interquartile range, 24-69). Post BET, IM at the GEJ (GEJIM) was detected in 188 (30%) patients, and recurrent dysplasia (low-grade dysplasia [LGD], 16; HGD, 21; EAC, 15) was detected in 52 (8.8%) patients in the absence of endoscopic BE during the study period.
The patients were also divided into the following groups: “never-GEJIM” (no history of recurrent GEJIM; n=429), “GEJIM-observed” (recurrent GEJIM but no BET; n=76), and “GEJIM-treated” (recurrent GEJIM that was treated with BET; n=85). The GEJIM-observed group had the lowest rate of dysplasia recurrence (0.6% per year; 2 of 76 patients) as compared to the never-GEJIM (2.6% per year; 40 of 429 patients) and GEJIM-treated groups (2.2% per year; 10 of 85 patients); the differences between the groups was not statistically significant (P=.07). Further analysis by histology suggested that the 3 groups (GEJIM-observed, GEJIM-treated, never-GEJIM) had similar rates of LGD (1 of 76 patients vs 5 of 85 patients vs 10 of 429 patients, respectively) and HGD/EAC (1 of 76 patients vs 5 of 85 patients vs 30 of 429 patients, respectively) (overall P=.23).
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Solfisburg QS, Sami SS, Gabre J, et al. Clinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett’s esophagus. Gastrointest Endosc 2020 Oct 31. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.10.027)