As noted previously in a related blog (Preventing Cancer in patients with Barrett’s Esophagus), Barrett’s esophagus (BE) is not a frequent issue in pediatric gastroenterology. However, some esophageal problems that start in childhood can predispose to this condition later in life. Certainly, BE is a frequent clinical issue in adult gastroenterology.
Three articles in this month’s Gastroenterology provide some useful information.
- Gastroenterology 2012; 143: 564-66
- Gastroenterology 2012; 143: 567-75
- Gastroenterology 2012; 143: 576-81
An editorial on these three articles is available on page 524.
The first reference describes three cases of high-grade dysplasia and adenocarcinoma that developed after ‘successful’ radiofrequency ablation (RFA). Thus, the authors advocate continued surveillance following RFA and caution in using RFA to patients with low-risk BE.
The second reference describes an elaborate model to determine if RFA is cost-effective. Based on their assumptions, “initial RFA might not be cost-effective for patients with BE without dysplasia.” Though, the authors indicate that one of the cost savings was that RFA was more effective and less costly than endoscopic surveillance. The authors acknowledge that their analysis is limited by assumptions and that the only alternative would be a large multicenter randomized trial with a long followup.
The third study examined 37 RFA patients. 22 were classified as complete responders and 15 were incomplete; complete responders had no intestinal metaplasia after fewer than 3 ablation sessions. Risks for persistent intestinal metaplasia were uncontrolled weakly acidic reflux despite twice-daily PPI therapy, longer length of BE, and larger hiatal hernias.