{"id":171,"date":"2010-03-01T12:37:04","date_gmt":"2010-03-01T16:37:04","guid":{"rendered":"http:\/\/blogstemp3.wpengine.com\/?p=171"},"modified":"2010-03-01T12:37:04","modified_gmt":"2010-03-01T16:37:04","slug":"when-should-we-stop-surveillance-of-barretts-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/when-should-we-stop-surveillance-of-barretts-patients\/2010\/03\/01\/","title":{"rendered":"When Should We Stop Surveillance of Barrett\u2019s Patients?"},"content":{"rendered":"<p><span>Some of my patients who have undergone successful ablation therapy for Barrett\u2019s esophagus ask a really good question: If I haven\u2019t had Barrett\u2019s for years, why do I need to keep having endoscopies?\u201d <\/span><\/p>\n<p><span>I admit, I do not have a uniform answer for that, nor do GI society guidelines. I would say that for patients who have never had dysplasia, surveillance is difficult to justify anyway, so we should \u201ccut them loose\u201d once we are sure their Barrett\u2019s is gone. But I\u2019ve heard many experts say that patients who have had dysplasia can never be let out of surveillance.<\/span><\/p>\n<p><span>Why should we approach patients who had dysplasia any differently than those who had adenomatous polyps? After all, adenomas are dysplastic and, as with dysplastic Barrett\u2019s (especially low-grade Barrett\u2019s), are associated with only modest cancer risk. Moreover, when we remove an adenoma, we no longer worry about that site; rather, we worry about the rest of the colon because that is where recurrence takes place. After ablation, Barrett\u2019s is gone, so why the continued intensive surveillance? <\/span><\/p>\n<p><span>I don\u2019t buy the argument that Barrett\u2019s is left behind; missed buried glands are rare in patients whose biopsies are all negative after ablation. Furthermore, even oncologists consider cancer patients cured after 5 years of disease-free survival and no longer put them through surveillance imaging and blood tests.<\/span><\/p>\n<p><span>So why are gastroenterologists resistant to the concept of \u201ccutting loose\u201d our Barrett\u2019s patients, even after 5 or more years of negative endoscopies and biopsies? Let me know what you think. I have thick skin, so pile it on!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Some of my patients who have undergone successful ablation therapy for Barrett\u2019s esophagus ask a really good question: If I haven\u2019t had Barrett\u2019s for years, why do I need to keep having endoscopies?\u201d I admit, I do not have a uniform answer for that, nor do GI society guidelines. I would say that for patients [&hellip;]<\/p>\n","protected":false},"author":28,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6,13],"tags":[35,36],"class_list":["post-171","post","type-post","status-publish","format-standard","hentry","category-endoscopy","category-patient-care","tag-endoscopy","tag-gastroenterology"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/171","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/comments?post=171"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/171\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/media?parent=171"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/categories?post=171"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/tags?post=171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}