Gut Check on Gastroenterology Archive

Gut Check on Gastroenterology, an NEJM Journal Watch blog focusing on issues in clinical gastroenterology, was active from 2008 to 2014. This archive contains all posts and discussions from Gut Check’s history.

July 16th, 2013

Follow-up after Barrett esophagus ablation: How do you do it, and when do you stop (if ever)?

We have shifted the paradigm of treating neoplastic Barrett esophagus (BE) away from a choice between intensive surveillance or surgery and towards endoscopic ablation. In the last 5 years, I have done hundreds of BE ablations using radiofrequency ablation (RFA) and endoscopic mucosal resection (EMR), and many thousands have been performed worldwide. However, on post-ablation surveillance, evidence is lacking on whether and when patients can be cut loose. Moreover, I am beginning to see patients who were believed to be cured after ablation (no signs of BE or neoplasia during years of surveillance) showing up with adenocarcinoma in the distal esophagus 4 or more years later.

Until now, I have been telling my patients that once they are BE- and dysplasia-free, I want them to undergo surveillance every 4 months for 1 year, then every 6 months for 1 year, then yearly for a couple of years, and then every other year if things remain stable.

But given the uncertainties I’ve outlined above, I am interested in discussing your practices and recommendations for surveillance after ablation for BE.

On that note, what would your approach be in the following cases?

1) If a patient with high-grade dysplasia has their BE completely ablated (no BE and no dysplasia), what surveillance period do you recommend for the following year? Year two? Beyond 2 years?

2) If a patient with low-grade dysplasia has their BE completely ablated (no BE and no dysplasia), what surveillance period do you recommend for the following year? Year two? Beyond 2 years?

3) If a patient with NO dysplasia has their BE completely ablated (no BE and no dysplasia), what surveillance period do you recommend for the following year? Year two? Beyond 2 years?

4) Do you ever tell patients that they are cured and no longer need surveillance (e.g., after 5 years, after 10 years, etc.)?

5) If a patient with dysplasia has their neoplastic BE completely ablated (no dysplasia but residual BE), what surveillance period do you recommend for the following year? Year two? Beyond 2 years?

Please join the discussion to shed some light on this issue.

Categories: Barrett esophagus, cancer surveillance, Patient care, practice environment, Uncategorized


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Gastroenterology Research: Author M. Brian Fennerty, M.D.

M. Brian Fennerty, MD

Founding Editor

NEJM Journal Watch Gastroenterology

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