Common Site of Recurrent Intestinal Metaplasia After Radiofrequency Ablation for Barrettʼs Esophagus

Abstract

Introduction: Radiofrequency ablation is considered an effective treatment for complete eradication of intestinal metaplasia (CEIM) in patients with Barrett's esophagus (BE). Recurrence however is common after CEIM and there is limited reporting of the anatomic location and endoscopic findings of recurrent disease. Methods: A retrospective cohort study performed at a single academic referral center evaluated 130 patients with RFA-treated BE that achieved CEIM and underwent at least 1 surveillance endoscopy. Results: In a mean 2.4 years of follow up, 23 patients had recurrence of disease (n=20; intestinal metaplasia, n=1; low grade dysplasia, n=1; high grade dysplasia, n=1; intramucosal cancer). Survival analysis found the percentage of patients with recurrent disease at the mean follow up was 19.2% (95% confidence interval [CI]: 12.5%-28.8%). The rate of recurrence was 7.4 (CI: 4.9-11.1) per 100 person years and no patients were found to have progression of disease after CEIM when considering histologic severity at or before treatment. Of the patients who had recurrent disease, 91% had evidence of dysplasia or intramucosal adenocarcinoma at or before treatment. The gastroesophageal junction (GEJ) was the most common site of recurrence (61%). Conclusion: Limited data exists regarding site of recurrent intestinal metaplasia after CEIM is achieved. In our retrospective surveillance cohort, we found that the location of recurrence tends to occur most commonly at the GEJ. Our findings support, random biopsies for surveillance be directed to the area at and around the GEJ.