title: Patterns of recurrent and persistent intestinal metaplasia after successful radiofrequency ablation of Barrett's esophagus.
abstract: OBJECTIVE
  Radiofrequency ablation can eradicate Barrett's esophagus successfully in the majority of cases. We sought to determine (1) how often intestinal metaplasia is detected during follow-up endoscopy after successful ablation and (2) patterns of persistent/recurrent intestinal metaplasia.
  
  
  METHODS
  Patients ablated successfully during a phase II clinical trial of radiofrequency ablation for Barrett's esophagus were followed using endoscopic surveillance according to a defined protocol. Systematic biopsies were performed in all patients throughout the neosquamous epithelium as well as at the gastroesophageal junction, and patterns of recurrent or persistent intestinal metaplasia were documented.
  
  
  RESULTS
  Fifty-three patients were ablated successfully during this single-institution clinical trial. A total of 151 follow-up endoscopies were performed (range, 1-5 endoscopies per patient) and 2492 biopsies were obtained, of which 604 (24%) were from the gastroesophageal junction. The median follow-up period was 18 months (range, 3-50 months). Recurrent/persistent intestinal metaplasia was detected in 14 patients (26%) in 3 distinct patterns: endoscopically invisible intestinal metaplasia underneath the neosquamous epithelium (buried glands) in 3 patients, visible recurrence in the tubular esophagus in 3 patients, and intestinal metaplasia of the gastroesophageal junction (with a squamous-lined tubular esophagus) in 10 patients. Dysplasia or cancer was not detected in any patient during the follow-up period.
  
  
  CONCLUSIONS
  Recurrent/persistent intestinal metaplasia after successful radiofrequency ablation of Barrett's esophagus is relatively common. This finding has implications for the continued surveillance of patients who are ablated successfully.
authors.affiliation: The Daniel and Gloria Blumenthal Cancer Center, Paramus, NJ 07652, USA. korsro@valleyhealth.com
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Korst
authors.forename: Sobeida
authors.initials: S
authors.lastname: Santana-Joseph
authors.forename: John R
authors.initials: JR
authors.lastname: Rutledge
authors.forename: Arthur
authors.initials: A
authors.lastname: Antler
authors.forename: Vivian
authors.initials: V
authors.lastname: Bethala
authors.forename: Anthony
authors.initials: A
authors.lastname: DeLillo
authors.forename: Donald
authors.initials: D
authors.lastname: Kutner
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Lee
authors.forename: Haleh
authors.initials: H
authors.lastname: Pazwash
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pittman
authors.forename: Michael
authors.initials: M
authors.lastname: Rahmin
authors.forename: Mitchell
authors.initials: M
authors.lastname: Rubinoff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D017115:Catheter Ablation; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology*; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome