Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy: development of a simplified surveillance biopsy strategy

Mahmoud Omar, Adarsh M. Thaker, Sachin Wani, Violette Simon, Eze Ezekwe, M. Boniface, Steven Edmundowicz, Joshua Obuch, Birtukan Cinnor, Brian C. Brauer, Mariah Wood, Dayna S. Early, Gabriel D. Lang, Daniel Mullady, Thomas Hollander, Vladimir Kushnir, Srinadh Komanduri, V. Raman Muthusamy*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
Pages (from-to)395-403
Number of pages9
JournalGastrointestinal endoscopy
Volume90
Issue number3
DOIs
StatePublished - Sep 1 2019

Fingerprint

Barrett Esophagus
Biopsy
Recurrence
Therapeutics
Metaplasia
Endoscopy
Expert Testimony
Esophagus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

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. / Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy : development of a simplified surveillance biopsy strategy. In: Gastrointestinal endoscopy. 2019 ; Vol. 90, No. 3. pp. 395-403.
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title = "Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy: development of a simplified surveillance biopsy strategy",
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.)",
author = "Mahmoud Omar and Thaker, {Adarsh M.} and Sachin Wani and Violette Simon and Eze Ezekwe and M. Boniface and Steven Edmundowicz and Joshua Obuch and Birtukan Cinnor and Brauer, {Brian C.} and Mariah Wood and Early, {Dayna S.} and Lang, {Gabriel D.} and Daniel Mullady and Thomas Hollander and Vladimir Kushnir and Srinadh Komanduri and Muthusamy, {V. Raman}",
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Omar, M, Thaker, AM, Wani, S, Simon, V, Ezekwe, E, Boniface, M, Edmundowicz, S, Obuch, J, Cinnor, B, Brauer, BC, Wood, M, Early, DS, Lang, GD, Mullady, D, Hollander, T, Kushnir, V, Komanduri, S & Muthusamy, VR 2019, 'Anatomic location of Barrett's esophagus recurrence after endoscopic eradication therapy: development of a simplified surveillance biopsy strategy', Gastrointestinal endoscopy, vol. 90, no. 3, pp. 395-403. https://doi.org/10.1016/j.gie.2019.04.216

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 journalArticle

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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U2 - 10.1016/j.gie.2019.04.216

DO - 10.1016/j.gie.2019.04.216

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JF - Gastrointestinal Endoscopy

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