P Sharma1, A Bhattacharyya, H S Garewal, R E Sampliner. 1. Departmentof Internal Medicine, Section of Gastroenterology, University of Arizona Health Sciences Center and Tucson VA Medical Center, USA.
Abstract
BACKGROUND: Endoscopic reversal of Barrett's esophagus with multipolar electrocoagulation and high-dose omeprazole has been previously described but long-term results are not available. The aim of this study was to follow patients after endoscopic reversal and to perform a detailed analysis of the "new" squamous mucosa. METHODS: After reversal, patients with Barrett's esophagus were maintained on high-dose omeprazole and underwent interval endoscopy, and large biopsies were obtained of the former Barrett's epithelium. RESULTS: Nine of 11 patients were men; the mean age was 62 years. The mean length of Barrett's mucosa was 4.4 cm; the mean dose of omeprazole used was 49 mg/day. All patients had an initial complete response to treatment-no evidence of Barrett's endoscopically and histologically. Three patients had intestinal metaplasia underlying the new squamous mucosa in the latest follow-up biopsies. In these 3 patients, only 0.4%, 2%, and 8% of the total biopsy area had intestinal metaplasia. All but 4 patients had underlying intestinal metaplasia at variable times during the study period. Patients have been followed for a mean of 36 months (range 19 to 53 months). CONCLUSIONS: New squamous mucosa is durable and resembles normal squamous tissue. Underlying glands of intestinal metaplasia are intermittently found. Because the significance of this residual intestinal metaplasia is unclear, surveillance endoscopy with biopsies of the treated segment is recommended even after reversal therapy.
BACKGROUND: Endoscopic reversal of Barrett's esophagus with multipolar electrocoagulation and high-dose omeprazole has been previously described but long-term results are not available. The aim of this study was to follow patients after endoscopic reversal and to perform a detailed analysis of the "new" squamous mucosa. METHODS: After reversal, patients with Barrett's esophagus were maintained on high-dose omeprazole and underwent interval endoscopy, and large biopsies were obtained of the former Barrett's epithelium. RESULTS: Nine of 11 patients were men; the mean age was 62 years. The mean length of Barrett's mucosa was 4.4 cm; the mean dose of omeprazole used was 49 mg/day. All patients had an initial complete response to treatment-no evidence of Barrett's endoscopically and histologically. Three patients had intestinal metaplasia underlying the new squamous mucosa in the latest follow-up biopsies. In these 3 patients, only 0.4%, 2%, and 8% of the total biopsy area had intestinal metaplasia. All but 4 patients had underlying intestinal metaplasia at variable times during the study period. Patients have been followed for a mean of 36 months (range 19 to 53 months). CONCLUSIONS: New squamous mucosa is durable and resembles normal squamous tissue. Underlying glands of intestinal metaplasia are intermittently found. Because the significance of this residual intestinal metaplasia is unclear, surveillance endoscopy with biopsies of the treated segment is recommended even after reversal therapy.
Authors: Bruce D Greenwald; Charles J Lightdale; Julian A Abrams; John D Horwhat; Ram Chuttani; Srinadh Komanduri; Melissa P Upton; Henry D Appelman; Helen M Shields; Nicholas J Shaheen; Stephen J Sontag Journal: Ann N Y Acad Sci Date: 2011-09 Impact factor: 5.691