Esophagus to Small Intestine
Clin Gastroenterol Hepatol. 2023;21(9):2260–9.e9
Clinical relevance of random biopsies from the esophagogastric junction after complete eradication of Barrett’s esophagus is low
Background and aims: Although random histological sampling from the esophagogastric junction (EGJ) after complete eradication of Barrett’s esophagus (BE) is recommended, its clinical relevance is questionable. This study aimed to assess the incidence and long-term outcomes of findings from random EGJ biopsies in a nationwide cohort with long-term follow-up.
Methods: The authors included all patients with successful endoscopic eradication therapy (EET), defined as complete endoscopic eradication of all visible BE (CE-BE), for early BE neoplasia from the Dutch registry. Patients were treated and followed-up in 9 expert centers according to a joint protocol. Outcomes included the incidence of intestinal metaplasia (IM) at the EGJ (EGJ-IM) and the association between IM and visible (dysplastic) BE recurrence.
Results: A total of 1154 patients were included with a median follow-up of 43 months (interquartile range [IQR], 22–69 months). At the time of CE-BE, persisting EGJ-IM was found in 7% of patients (78/1154), which was reproduced during further follow-up in 46% of patients (42/78). No significant association existed between persisting EGJ-IM at CE-BE and recurrent non-dysplastic or dysplastic BE (hazard ratio [HR] = 1.15; 95% confidence interval [CI]: 0.63–2.13 and HR = 0.73; 95% CI: 0.17–3.06, respectively). Among patients with no EGJ-IM at the time of CE-BE (1043/1154; 90%), EGJ-IM recurred in 7% (72/1043) after a median of 21 months (IQR, 15–36 months), and was reproduced during further follow-up in 26% of patients (19/72). No association was found between recurrent EGJ-IM and non-dysplastic or dysplastic recurrence (HR = 1.18; 95% CI: 0.67–2.06 and HR = 0.27; 95% CI: 0.04–1.96, respectively).
Conclusion: Because intestinal metaplasia at the esophagogastric junction (EGJ) was not associated with a higher risk for recurrent disease, it is recommended to consider abandoning random EGJ sampling after successful endoscopic eradication therapy, under the condition that care is provided in expert centers, and the esophagus, including the EGJ, is carefully inspected.