Swathi Eluri1, Athidi G Earasi2, Susan E Moist3, Evan S Dellon2, Nicholas J Shaheen2. 1. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: swathi@med.unc.edu. 2. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 3. Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Abstract
BACKGROUND & AIMS: Endoscopic eradication therapy (EET) for Barrett's esophagus (BE) has unclear effects on the gastric cardia. We investigated the prevalence of intestinal metaplasia (IM) and dysplasia in the cardia after complete eradication of IM (CEIM) and the incidence of newly diagnosed cardia IM or dysplasia after EET. METHODS: We performed a prospective study, from 2013 through 2016, of patients with previously successful EET undergoing surveillance after CEIM (cross-sectional group) and treatment-naïve patients with BE undergoing EET (longitudinal group). Standard biopsies were collected from multiple levels in the cardia and analyzed histologically. We calculated the prevalence (cross-sectional group) and the incidence (longitudinal group) of cardia IM or dysplasia after EET. RESULTS: Of the 116 patients in the cross-sectional group, 17 (15%) had cardia IM or dysplasia after CEIM: 12 patients had IM, 2 patients were indefinite for dysplasia, and 3 patients had low-grade dysplasia. Cardia IM or dysplasia were most commonly found at the tops of gastric folds. Among 42 subjects in the longitudinal group, the pre-treatment prevalence of cardia IM or dysplasia was 28.5% (3 with non-dysplastic IM, 9 with dysplastic IM, 1 indefinite for dysplasia, 2 with low-grade dysplasia, 3 with high-grade dysplasia, and 3 with intramucosal cancer). All achieved CEIM. The incidence of cardia IM or dysplasia was 11.9% after 18 months of follow up. IM or dysplasia was more higher in the cardia after CEIM than in the tubular esophagus (P < .01). CONCLUSIONS: In a prospective study, we found that cardia dysplasia becomes less, not more, common, after successful EET; recurrence of IM or dysplasia was more frequent in the cardia than the esophagus. Patients with BE undergoing EET should have careful examination of the cardia, with a single set of surveillance biopsies at the top of the gastric folds.
BACKGROUND & AIMS: Endoscopic eradication therapy (EET) for Barrett's esophagus (BE) has unclear effects on the gastric cardia. We investigated the prevalence of intestinal metaplasia (IM) and dysplasia in the cardia after complete eradication of IM (CEIM) and the incidence of newly diagnosed cardia IM or dysplasia after EET. METHODS: We performed a prospective study, from 2013 through 2016, of patients with previously successful EET undergoing surveillance after CEIM (cross-sectional group) and treatment-naïve patients with BE undergoing EET (longitudinal group). Standard biopsies were collected from multiple levels in the cardia and analyzed histologically. We calculated the prevalence (cross-sectional group) and the incidence (longitudinal group) of cardia IM or dysplasia after EET. RESULTS: Of the 116 patients in the cross-sectional group, 17 (15%) had cardia IM or dysplasia after CEIM: 12 patients had IM, 2 patients were indefinite for dysplasia, and 3 patients had low-grade dysplasia. Cardia IM or dysplasia were most commonly found at the tops of gastric folds. Among 42 subjects in the longitudinal group, the pre-treatment prevalence of cardia IM or dysplasia was 28.5% (3 with non-dysplastic IM, 9 with dysplastic IM, 1 indefinite for dysplasia, 2 with low-grade dysplasia, 3 with high-grade dysplasia, and 3 with intramucosal cancer). All achieved CEIM. The incidence of cardia IM or dysplasia was 11.9% after 18 months of follow up. IM or dysplasia was more higher in the cardia after CEIM than in the tubular esophagus (P < .01). CONCLUSIONS: In a prospective study, we found that cardia dysplasia becomes less, not more, common, after successful EET; recurrence of IM or dysplasia was more frequent in the cardia than the esophagus. Patients with BE undergoing EET should have careful examination of the cardia, with a single set of surveillance biopsies at the top of the gastric folds.
Authors: Bergein F Overholt; Charles J Lightdale; Kenneth K Wang; Marcia I Canto; Steven Burdick; Roger C Haggitt; Mary P Bronner; Shari L Taylor; Michael G A Grace; Michelle Depot Journal: Gastrointest Endosc Date: 2005-10 Impact factor: 9.427
Authors: K Nadine Phoa; Roos E Pouw; Raf Bisschops; Oliver Pech; Krish Ragunath; Bas L A M Weusten; Brigitte Schumacher; Bjorn Rembacken; Alexander Meining; Helmut Messmann; Erik J Schoon; Liebwin Gossner; Jayan Mannath; C A Seldenrijk; Mike Visser; Toni Lerut; Stefan Seewald; Fiebo J ten Kate; Christian Ell; Horst Neuhaus; Jacques J G H M Bergman Journal: Gut Date: 2015-03-02 Impact factor: 23.059
Authors: E S Dellon; L L Higgins; R Beitia; S Rusin; J T Woosley; R Veerappan; S R Selitsky; J S Parker; R M Genta; R H Lash; R Aranda; R J Peach; M Grimm Journal: Aliment Pharmacol Ther Date: 2016-05-18 Impact factor: 8.171
Authors: Nicholas J Shaheen; Prateek Sharma; Bergein F Overholt; Herbert C Wolfsen; Richard E Sampliner; Kenneth K Wang; Joseph A Galanko; Mary P Bronner; John R Goldblum; Ana E Bennett; Blair A Jobe; Glenn M Eisen; M Brian Fennerty; John G Hunter; David E Fleischer; Virender K Sharma; Robert H Hawes; Brenda J Hoffman; Richard I Rothstein; Stuart R Gordon; Hiroshi Mashimo; Kenneth J Chang; V Raman Muthusamy; Steven A Edmundowicz; Stuart J Spechler; Ali A Siddiqui; Rhonda F Souza; Anthony Infantolino; Gary W Falk; Michael B Kimmey; Ryan D Madanick; Amitabh Chak; Charles J Lightdale Journal: N Engl J Med Date: 2009-05-28 Impact factor: 91.245