title: Buried metaplasia after endoscopic ablation of Barrett's esophagus: a systematic review.
abstract: OBJECTIVE
  Endoscopic ablation of Barrett's esophagus can bury metaplastic glands under a layer of neosquamous epithelium. To explore the frequency and importance of buried metaplasia, we have conducted a systematic review of reports on endoscopic ablation.
  
  
  METHODS
  We performed computerized and manual searches for articles on the results of photodynamic therapy (PDT) and radiofrequency ablation (RFA) for Barrett's esophagus. We extracted information on the number of patients treated, biopsy protocol, biopsy depth, and frequency of buried metaplasia.
  
  
  RESULTS
  We found 9 articles describing 34 patients with neoplasia appearing in buried metaplasia (31 after PDT). We found five articles describing a baseline prevalence of buried metaplasia (before ablation) ranging from 0% to 28%. In 22 reports on PDT for 953 patients, buried metaplasia was found in 135 (14.2%); in 18 reports on RFA for 1,004 patients, buried metaplasia was found in only 9 (0.9%). A major problem limiting the conclusions that can be drawn from these reports is that they do not describe specifically how frequently biopsy specimens contained sufficient subepithelial lamina propria to be informative for buried metaplasia.
  
  
  CONCLUSIONS
  Endoscopic ablation can bury metaplastic glands with neoplastic potential but, even without ablation, buried metaplasia often is found in areas where Barrett's epithelium abuts squamous epithelium. Buried metaplasia is reported less frequently after RFA than after PDT. However, available reports do not provide crucial information on the adequacy of biopsy specimens and, therefore, the frequency and importance of buried metaplasia after endoscopic ablation remain unclear.
authors.affiliation: Department of Medicine, VA North Texas Healthcare System and the University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Nathan A
authors.initials: NA
authors.lastname: Gray
authors.forename: Robert D
authors.initials: RD
authors.lastname: Odze
authors.forename: Stuart Jon
authors.initials: SJ
authors.lastname: Spechler
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D004945:Esophagoscopy; D006801:Humans; D008679:Metaplasia; D010778:Photochemotherapy / Q000009:adverse effects*