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.<\/p>\n
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.<\/p>\n
But given the uncertainties I\u2019ve outlined above, I am interested in discussing your practices and recommendations for surveillance after ablation for BE.<\/p>\n
On that note, what would your approach be in the following cases?<\/p>\n
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?<\/p>\n
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?<\/p>\n
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?<\/p>\n
4) Do you ever tell patients that they are cured and no longer need surveillance (e.g., after 5 years, after 10 years, etc.)?<\/p>\n
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?<\/p>\n
Please join the discussion to shed some light on this issue.<\/p>\n","protected":false},"excerpt":{"rendered":"
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 […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3,13,15,1],"tags":[],"class_list":["post-512","post","type-post","status-publish","format-standard","hentry","category-barrett-esophagus","category-cancer-surveillance","category-patient-care","category-practice-environment","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/512","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\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/comments?post=512"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/posts\/512\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/media?parent=512"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/categories?post=512"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/gastroenterology\/index.php\/wp-json\/wp\/v2\/tags?post=512"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}