Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4297-4306
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4297
Post-ablation surveillance in Barrett's esophagus: A review of the literature
Matthew W Stier, Vani J Konda, John Hart, Irving Waxman
Matthew W Stier, Department of Internal Medicine, The University of Chicago Medicine, Chicago, IL 60637, United States
Vani J Konda, Irving Waxman, Division of Gastroenterology, Department of Medicine, The University of Chicago Medicine, Chicago, IL 60637, United States
John Hart, Department of Pathology, The University of Chicago Medicine, Chicago, IL 60637, United States
Author contributions: Konda VJ, Hart J and Waxman I designed the concept for the review article; Stier MW, Konda VJ and Waxman I performed literature review; Hart J reviewed images for inclusion; Stier MW wrote the paper; all members contributed equally to its editing and revision.
Conflict-of-interest statement: No potential conflicts of interest or outside financial support was provided to any of the contributing authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Matthew W Stier, MD, Department of Internal Medicine, The University of Chicago Medicine, 5841 South Maryland Avenue MC 3051, Chicago, IL 60637, United States. matthew.stier@uchospitals.edu
Telephone: +1-309-2873838 Fax: +1-772-7022230
Received: July 16, 2015
Peer-review started: July 18, 2015
First decision: September 29, 2015
Revised: December 8, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: May 7, 2016
Processing time: 288 Days and 5.2 Hours
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.