Conference Coverage

Endoscopic therapy for Barrett’s: highly effective, but not perfect


 

EXPERT ANALYSIS FROM PERSPECTIVES IN DIGESTIVE DISEASES

– While endoscopic therapy of Barrett’s esophagus is often successful, the risk of recurrence after complete ablation remains considerable, according to Prateek Sharma, MD, of the department of medicine in the division of gastroenterology and hepatology at the University of Kansas, Kansas City.

“This is not perfect therapy,” Dr. Sharma said in a presentation at the inaugural Perspectives in Digestive Diseases meeting held by Global Academy for Medical Education.

Dr. Prateek Sharma professor of medicine, University of Kansas School of Medicine, Kansas City.

Dr. Prateek Sharma

In his presentation, Dr. Sharma highlighted a recent meta-analysis of nearly 4,500 patients who had complete remission of intestinal metaplasia with endoscopic therapy.

The risk of recurrence for intestinal metaplasia was 7.1% per patient-year, authors of that study found. The risk of dysplastic Barrett’s esophagus was 1.3% per patient-year in the meta-analysis, while the risk of high-grade dysplasia or esophageal adenocarcinoma was 0.8%.

Because of these risks, patients should be followed up regularly with careful examination and biopsies to ensure there is no recurrent intestinal metaplasia, dysplasia, or adenocarcinoma, Dr. Sharma told attendees at the meeting.

“If it comes back, you can still treat it endoscopically,” he continued, “but you have to be aware of the situation, and inform the patient that it can be curative, but at the same time it’s not a 100% success story in all situations.”

When patients do develop early cancers or high-grade lesions, the latest evidence suggests endoscopic therapy is effective and helps avoid esophagectomy in the majority of patients.

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