Abstract
Background and Aims: Surveillance endoscopy is recommended after endoscopic eradication therapy (EET) for Barrett's esophagus (BE) because of the risk of recurrence. Currently recommended biopsy protocols are based on expert opinion and consist of sampling visible lesions followed by random 4-quadrant biopsy sampling throughout the length of the original BE segment. Despite this protocol, some recurrences are not visibly identified. We aimed to identify the anatomic location and histology of recurrences after successful EET with the goal of developing a more efficient and evidence-based surveillance biopsy protocol. Methods: We performed an analysis of a large multicenter database of 443 patients who underwent EET and achieved complete eradication of intestinal metaplasia (CE-IM) from 2005 to 2015. The endoscopic location of recurrence relative to the squamocolumnar junction (SCJ), visible recurrence identified during surveillance endoscopy, and time to recurrence after CE-IM were assessed. Results: Fifty patients with BE recurrence were studied in the final analysis. Seventeen patients (34%) had nonvisible recurrences. In this group, biopsy specimens demonstrating recurrence were taken from within 2 cm of the SCJ in 16 of these 17 patients (94%). Overall, 49 of 50 recurrences (98%) occurred either within 2 cm of the SCJ or at the site of a visible lesion. Late recurrences (>1 year) were more likely to be visible than early (<1 year) recurrences (P = .006). Conclusions: Recurrence after EET detected by random biopsy sampling is identified predominately in the distal esophagus and occurs earlier than visible recurrences. As such, we suggest a modified biopsy protocol with targeted sampling of visible lesions followed by random biopsy sampling within 2 cm of the SCJ to optimize detection of recurrence after EET. (Clinical trial registration number: NCT02634645.)
| Original language | English (US) |
|---|---|
| Pages (from-to) | 395-403 |
| Number of pages | 9 |
| Journal | Gastrointestinal endoscopy |
| Volume | 90 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2019 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Gastroenterology
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Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy : development of a simplified surveillance biopsy strategy. / Omar, Mahmoud; Thaker, Adarsh M.; Wani, Sachin; Simon, Violette; Ezekwe, Eze; Boniface, M.; Edmundowicz, Steven; Obuch, Joshua; Cinnor, Birtukan; Brauer, Brian C.; Wood, Mariah; Early, Dayna S.; Lang, Gabriel D.; Mullady, Daniel; Hollander, Thomas; Kushnir, Vladimir; Komanduri, Srinadh; Muthusamy, V. Raman.
In: Gastrointestinal endoscopy, Vol. 90, No. 3, 01.09.2019, p. 395-403.Research output: Contribution to journal › Article
TY - JOUR
T1 - Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy
T2 - development of a simplified surveillance biopsy strategy
AU - Omar, Mahmoud
AU - Thaker, Adarsh M.
AU - Wani, Sachin
AU - Simon, Violette
AU - Ezekwe, Eze
AU - Boniface, M.
AU - Edmundowicz, Steven
AU - Obuch, Joshua
AU - Cinnor, Birtukan
AU - Brauer, Brian C.
AU - Wood, Mariah
AU - Early, Dayna S.
AU - Lang, Gabriel D.
AU - Mullady, Daniel
AU - Hollander, Thomas
AU - Kushnir, Vladimir
AU - Komanduri, Srinadh
AU - Muthusamy, V. Raman
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background and Aims: Surveillance endoscopy is recommended after endoscopic eradication therapy (EET) for Barrett's esophagus (BE) because of the risk of recurrence. Currently recommended biopsy protocols are based on expert opinion and consist of sampling visible lesions followed by random 4-quadrant biopsy sampling throughout the length of the original BE segment. Despite this protocol, some recurrences are not visibly identified. We aimed to identify the anatomic location and histology of recurrences after successful EET with the goal of developing a more efficient and evidence-based surveillance biopsy protocol. Methods: We performed an analysis of a large multicenter database of 443 patients who underwent EET and achieved complete eradication of intestinal metaplasia (CE-IM) from 2005 to 2015. The endoscopic location of recurrence relative to the squamocolumnar junction (SCJ), visible recurrence identified during surveillance endoscopy, and time to recurrence after CE-IM were assessed. Results: Fifty patients with BE recurrence were studied in the final analysis. Seventeen patients (34%) had nonvisible recurrences. In this group, biopsy specimens demonstrating recurrence were taken from within 2 cm of the SCJ in 16 of these 17 patients (94%). Overall, 49 of 50 recurrences (98%) occurred either within 2 cm of the SCJ or at the site of a visible lesion. Late recurrences (>1 year) were more likely to be visible than early (<1 year) recurrences (P = .006). Conclusions: Recurrence after EET detected by random biopsy sampling is identified predominately in the distal esophagus and occurs earlier than visible recurrences. As such, we suggest a modified biopsy protocol with targeted sampling of visible lesions followed by random biopsy sampling within 2 cm of the SCJ to optimize detection of recurrence after EET. (Clinical trial registration number: NCT02634645.)
AB - Background and Aims: Surveillance endoscopy is recommended after endoscopic eradication therapy (EET) for Barrett's esophagus (BE) because of the risk of recurrence. Currently recommended biopsy protocols are based on expert opinion and consist of sampling visible lesions followed by random 4-quadrant biopsy sampling throughout the length of the original BE segment. Despite this protocol, some recurrences are not visibly identified. We aimed to identify the anatomic location and histology of recurrences after successful EET with the goal of developing a more efficient and evidence-based surveillance biopsy protocol. Methods: We performed an analysis of a large multicenter database of 443 patients who underwent EET and achieved complete eradication of intestinal metaplasia (CE-IM) from 2005 to 2015. The endoscopic location of recurrence relative to the squamocolumnar junction (SCJ), visible recurrence identified during surveillance endoscopy, and time to recurrence after CE-IM were assessed. Results: Fifty patients with BE recurrence were studied in the final analysis. Seventeen patients (34%) had nonvisible recurrences. In this group, biopsy specimens demonstrating recurrence were taken from within 2 cm of the SCJ in 16 of these 17 patients (94%). Overall, 49 of 50 recurrences (98%) occurred either within 2 cm of the SCJ or at the site of a visible lesion. Late recurrences (>1 year) were more likely to be visible than early (<1 year) recurrences (P = .006). Conclusions: Recurrence after EET detected by random biopsy sampling is identified predominately in the distal esophagus and occurs earlier than visible recurrences. As such, we suggest a modified biopsy protocol with targeted sampling of visible lesions followed by random biopsy sampling within 2 cm of the SCJ to optimize detection of recurrence after EET. (Clinical trial registration number: NCT02634645.)
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UR - http://www.scopus.com/inward/citedby.url?scp=85066940548&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2019.04.216
DO - 10.1016/j.gie.2019.04.216
M3 - Article
C2 - 31004598
AN - SCOPUS:85066940548
VL - 90
SP - 395
EP - 403
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 3
ER -