Endoscopy, Table of Contents

Endoscopy 2013; 45(07): 571-574
DOI: 10.1055/s-0032-1326419

Case report/series

© Georg Thieme Verlag KG Stuttgart · New York

Recurrence of subsquamous dysplasia and carcinoma after successful endoscopic and radiofrequency ablation therapy for dysplastic Barrett’s esophagus

J. K. Lee

¹Department of Medicine and Division of Gastroenterology, VA San Francisco Medical Center and University of California, San Francisco, California, USA

,

R. G. Cameron

²Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA

,

K. F. Binmoeller

²Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA

,

J. N. Shah

¹Department of Medicine and Division of Gastroenterology, VA San Francisco Medical Center and University of California, San Francisco, California, USA

²Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA

,

A. Shergill

¹Department of Medicine and Division of Gastroenterology, VA San Francisco Medical Center and University of California, San Francisco, California, USA

,

R. Garcia-Kennedy

²Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA

,

Y. M. Bhat

¹Department of Medicine and Division of Gastroenterology, VA San Francisco Medical Center and University of California, San Francisco, California, USA

²Paul May and Frank Stein Interventional Endoscopy Center, California Pacific Medical Center, San Francisco, California, USA

› Author Affiliations

Barrett’s esophagus with dysplasia is commonly treated with radiofrequency ablation (RFA). Despite its effectiveness, a concern of any ablative technique is the development of subsquamous intestinal metaplasia, which could have potential for future neoplastic progression. To date, 34 cases of subsquamous neoplasia have been described in the literature after various ablation therapies. However, only three cases of subsquamous neoplasia have been reported after successful RFA treatment of dysplastic Barrett’s esophagus. In this case series, we report on four additional cases of subsquamous neoplasia detected after successful endoscopic resection and RFA for neoplastic and dysplastic Barrett’s esophagus. All four patients were treated successfully with endoscopic resection of their recurrent subsquamous neoplastic and dysplastic lesions. This case series highlights the need for continued surveillance following successful treatment of dysplastic Barrett’s esophagus with RFA.

References
1 Ford AC, Forman D, Reynolds PD et al. Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol 2005; 162: 454-460
2 American Cancer Society ACS. Cancer facts & figures 2012. Atlanta: American Cancer Society; 2012
3 Pouw RE, Wirths K, Eisendrath P et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 2010; 8: 23-29
4 Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
5 Bennett C, Vakil N, Bergman J et al. Consensus statement for management of Barrett’s dysplasia and early stage esophageal adenocarcinoma, based on Delphi process. Gastroenterology 2012; 143: 336-346
6 Spechler SJ, Sharma P, Souza RF et al. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140: 1084-1091
7 Titi M, Overhiser A, Ulusarac O et al. Development of subsquamous high-grade dysplasia and adenocarcinoma after successful radiofrequency ablation of Barrett’s esophagus. Gastroenterology 2012; 143: 564-566
8 Gray NA, Odze RD, Spechler SJ. Buried metaplasia after endoscopic ablation for Barrett’s esophagus: a systematic review. Am J Gastroenterol 2011; 106: 1899-1908
9 Prasad GA, Wang KK, Halling KC et al. Utility of biomarkers in prediction of response to ablative therapy in Barrett’s esophagus. Gastroenterology 2008; 135: 370-379
10 Diamantis G, Bocus P, Realdon S et al. Role of confocal laser endomicroscopy in detection of residual Barrett’s esophagus after radiofrequency ablation. Case Rep Gastrointest Med 2011; 593923
11 Zhou C, Tsai TH, Lee HC et al. Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos). Gastrointest Endosc 2012; 75: 57-65
12 Pech O, Behrens A, May A et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut 2008; 57; 1200-1206
13 Pouw RE, Seewald S, Gondrie JJ et al. Stepwise radical endoscopic resection for eradication of Barrett’s oesophagus with early neoplasia in a cohort of 169 patients. Gut 2010; 598: 1169-1177