The Battle Zone of Barrett’s Endoscopic Therapy: The Gastric Cardia
Prateek Sharma, MD, FASGE, reviewing Eluri S, et al. Clin Gastroenterol Hepatol 2020 Jan.
Long-term durability of complete eradication of intestinal metaplasia (CE-IM) is the goal of Barrett’s endoscopic therapy (BET), but it can be difficult to achieve, especially in the gastric cardia, where recurrences happen in up to 20% of patients. Several studies have reported on the presence of cardia intestinal metaplasia (IM) and dysplasia prior to and after successful endoscopic therapy in patients with Barrett’s esophagus.
This prospective study at a single tertiary center included 116 patients who underwent BET and achieved CE-IM. Of these patients, 17 (15%) were noted to have cardia IM/dysplasia (IM-12, LGD/indefinite-5). Among another cohort of 42 patients who were followed longitudinally, 12 (28%) had cardia IM/dysplasia pre-BET. At the 6-month follow-up, none of the patients had cardia IM and 3 (8.6%) had dysplasia, and at the 18-month follow-up, 2 (6.2%) patients had cardia IM and no patients had dysplasia. Cardia nodularity was associated with dysplasia both before and after BET. The majority of the nodular lesions were treated by EMR (69%), followed by radiofrequency ablation (98%).
COMMENT
The cardia region is the battle zone in patients being considered for BET. Careful inspection of this region (immediately distal to the neo z line/top of gastric folds) is critical both prior to and after achieving CE-IM. Use of high-definition white-light endoscopy with virtual chromoendoscopy, if available, should be performed to recognize any visible abnormalities. Biopsies should be obtained prior to starting BET and after achieving CE-IM. Cardia dysplasia should be treated similar to BE dysplasia.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Prateek Sharma, MD, FASGE
CITATION(S)
Eluri S, Earasi AG, Moist SE, Dellon ES, Shaheen NJ. Prevalence and incidence of intestinal metaplasia and dysplasia of gastric cardia in patients with Barrett’s esophagus after endoscopic therapy. Clin Gastroenterol Hepatol 2020;18:82-88.e1. (https://doi.org/10.1016/j.cgh.2019.04.065)
