Endoscopic Surveillance of Columnar-Lined Esophagus: Frequency of Intestinal Metaplasia Detection and Impact of Antireflux Surgery

• Published in: The American journal of gastroenterology Vol. 98; no. 4; pp. 931 - 933
• Main Authors: Aguirre, Thomas V, Sampliner, Richard E
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01-04-2003
• Subjects: Gastroenterology
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2003.07356.x

The aim of this study was to evaluate the prevalence of intestinal metaplasia (IM) in patients with varying lengths of columnar-lined esophagus (CLE) during long-term surveillance. Further, the authors hoped to determine whether complete reflux prevention by medical or surgery therapy prevented the development of IM in CLE.Between the year 1979 and 1998, the authors prospectively enrolled patients with CLE into a surveillance program that included endoscopy every 1-2 yr. The majority of the patients were biopsied in a systematic fashion (four quadrant biopsies, every 2 cm). Patients without IM on the two initial endoscopies were deemed Barrett's free. The time separating the negative endoscopies and the appearance of goblet cells on subsequent endoscopies was identified as the time to metaplasia. The time to this occurrence was compared between patients with medically and surgically treated reflux.A total of 177 patients were enrolled, and 52% had IM on initial endoscopy. At the first endoscopy, 30% of patients with CLE 1-2 cm in length had IM. This was compared with 45% of patients with CLE 3-4 cm in length. After six endoscopies, the yield increased to 64% of patients with CLE 1-2 cm in length and 89% of patients with CLE 3-4 cm in length. Overall, patients with longer CLE (>4 cm) had IM discovered with fewer endoscopies than those with shorter CLE.A total of 69 patients had no IM on the initial two endoscopies. In this retrospective analysis, 49 had been treated with antireflux medication, and 20 were treated with surgery. Post-surgery pH studies showed that 48 of 49 patients had normal esophageal acid exposure. Esophageal pH studies were not reported for medically treated patients. The time to development of IM was shorter in medically treated patients (mean time 5.3 yr). Overall, 35 of 69 patients had IM on follow-up biopsies. Using a multivariant analysis, surgically treated reflux decreased the risk of development of IM by 10-fold.