Random sampling of esophagogastric junction may be unnecessary following BE eradication
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Follow-up esophagogastric junction sampling for intestinal metaplasia may not be necessary in patients after complete and successful eradication therapy for Barrett’s esophagus, researchers reported.
“Although indications and treatment protocol for [endoscopic eradication therapy] are well established, follow-up after successful treatment is less well defined,” C.N. Frederiks, MD, of the department of gastroenterology and hepatology at St. Antonius Hospital in the Netherlands, and colleagues wrote in Clinical Gastroenterology and Hepatology. “However, in the case of an endoscopically normal appearing esophagus, there is lack of consensus on the need for random biopsies from the esophagogastric junction (EGJ).”
They added, “Current guidelines recommend random biopsies in four quadrants of the EGJ. This procedure is not only time-consuming for endoscopists and pathologists, it also results in increased health-care costs. Moreover, it is our experience in daily clinical practice that the yield of these random EGJ biopsies is limited.”
In a nationwide cohort study, researchers analyzed the long-term outcomes of 1,154 patients with BE in the Barrett Expert Cancer registry who underwent successful endoscopic eradication therapy (EET) with radiofrequency ablation. Evaluated endpoints included the incidence of intestinal metaplasia (IM) at the EGJ (EGJ-IM) as well as the association between IM and visible, or dysplastic, BE.
After a median follow-up of 43 months, Frederiks and colleagues observed persisting EGJ-IM at the time of complete eradication among 7% of patients. During further follow-up, this was noted among 46% of patients with no “significant association” between persisting EGJ-IM at the time of complete eradication (HR = 1.15; 95% CI, 0.63-2.13) and recurrent nondysplastic or dysplastic BE (HR = 0.73; 95% CI, 0.17-3.06).
Among 1,043 patients with no EGJ-IM at the time of eradication, EGJ-IM recurred in 7% of patients after a median of 21 months, which was reported in 26% during further follow-up. Researchers observed no association between recurrent EGJ-IM (HR = 1.18; 95% CI, 0.67-2.06) and nondysplastic or dysplastic recurrence (HR = 0.27; 95% CI, 0.04-1.96).
“Persisting or recurrent EGJ-IM after successful EET was not associated with recurrence of BE with or without dysplasia,” Frederiks and colleagues concluded. “In fact, random sampling from a normal appearing EGJ did not result in clinically relevant findings. Therefore, we recommend abandoning random sampling of the EGJ after successful EET and during further follow-up, under condition that care is provided in expert centers, the esophagus including the EGJ is carefully inspected and targeted biopsies are taken at a low threshold in case of visible abnormalities or recurrent BE.”
They continued, “Ultimately, this will save time and costs for the endoscopist, the pathologist and the patient.”
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