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. 2013 Nov;78(5):696-701.
doi: 10.1016/j.gie.2013.04.196. Epub 2013 May 24.

A survey of expert follow-up practices after successful endoscopic eradication therapy for Barrett's esophagus with high-grade dysplasia and intramucosal adenocarcinoma

Aarti O Bedi  1 , Richard S Kwon, Joel H Rubenstein, Cyrus R Piraka, Grace H Elta, James M Scheiman, B Joseph Elmunzer
Affiliations

A survey of expert follow-up practices after successful endoscopic eradication therapy for Barrett's esophagus with high-grade dysplasia and intramucosal adenocarcinoma

Aarti O Bedi et al. Gastrointest Endosc. 2013 Nov.

Abstract

Background: Despite the increasing number of patients undergoing endoscopic therapy for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal cancer (IMC), there are few data to guide clinical decision making and research initiatives in the area of posttreatment follow-up.

Objectives: We aimed to define expert practice patterns regarding follow-up after endoscopic treatment of BE with HGD and IMC.

Design: Electronic survey.

Subjects: Forty-eight endoscopists in the United States with expertise in BE endotherapy based on high-impact publications and national reputation.

Intervention: A 21-item Web-based survey inquiring about post-BE endotherapy follow-up practices.

Results: Of 48 expert endoscopists, 42 completed the survey. After successful treatment of BE with HGD or IMC, all experts perform surveillance upper endoscopy, most commonly at 3-month intervals in the first posttreatment year, every 6 months during the second year, and annually thereafter. None of the experts perform surveillance EUS after treatment of HGD, and only 19% perform EUS after treatment of IMC. After cancer eradication, only 36% of experts refer patients for CT, and 24% refer patients for positron emission tomography. Thirty-eight percent of experts refer patients for a surgical opinion when IMC extends into the muscularis mucosa; 100% refer when IMC extends into submucosa.

Limitations: Not a consensus document; only U.S. experts included.

Conclusions: This study reports the follow-up practices of expert endoscopists after successful endotherapy for BE with HGD and IMC. Additional research is necessary to establish optimal surveillance intervals, the role of follow-up EUS, CT, and positron emission tomography, as well as the surgical implications of low-risk IMC extending into the muscularis mucosa.

Keywords: BE; Barrett's esophagus; HGD; IMC; PET; high-grade dysplasia; intramucosal cancer; positron emission tomography.

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Figures

Figure 1
Figure 1
Surveillance EGD frequency after endoscopic treatment of high-grade dysplasia (HGD) in Barrett's esophagus.
Figure 2
Figure 2
Surveillance EGD frequency after endoscopic treatment of intramucosal cancer (IMC) in Barrett's esophagus.
Figure 3
Figure 3
Surveillance EUS frequency after endoscopic treatment of intramucosal cancer (IMC) in Barrett's esophagus.
See this image and copyright information in PMC

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References

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