Post-ablation surveillance in Barrett's esophagus: A review of the literature

Abstract

Barrett’s esophagus (BE) is a pre-malignant condition affecting up to 15% of patients with gastroesophageal reflux disease. Neoplastic Barrett’s mucosa is defined as harboring high grade dysplasia or intra-mucosal cancer, and carries a high risk of progression to esophageal adenocarcinoma. The rising incidence of Barrett’s lesions along with the high morbidity of surgical approaches has led to the development of numerous validated endoscopic techniques capable of eradicating neoplastic mucosa in a minimally invasive manner. While there has been widespread adoption of these techniques, less is known about optimal surveillance intervals in the post-therapy period. This is due in part to limitations in current surveillance methods, questions about durability of treatment response and the risk of subendothelial progression. As we are now able to achieve organ sparing eradication of superficial neoplasia in BE, we need to also then focus our attention on how best to manage these patients after eradication is achieved. Implementing optimal surveillance practices requires additional understanding of the biology of the disease, appreciation of the limits of current tools and treatments, and exploration of the role of adjunctive technologies. The aim of this article is to provide a comprehensive review of current literature surrounding post-ablation surveillance in neoplastic BE.

Keywords: Barrett’s esophagus, Endotherapy, Post-ablation surveillance, Neoplastic, Radiofrequency ablation, Endoscopic mucosal resection

Core tip: Hybrid endotherapy has become common practice for neoplastic Barrett’s esophagus with many studies supporting its efficacy. There are limited data and recommendations on appropriate intervals of endoscopic surveillance in the post-therapy period. The purpose of this paper is to review the literature regarding endoscopic surveillance following current endotherapy strategies for neoplastic Barrett’s esophagus, discuss the deficiencies of current surveillance protocols, as well as to comment on the potential role of emerging modalities for monitoring disease progression in the post treatment setting.