Buried Barrett’s Esophagus—a Sheep in Sheep’s Clothing

Shafa, Shervin; Shaheen, Nicholas J.

doi:10.1007/s11605-016-3165-4

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…Early reports of dysplasia and cancer developing in buried Barrett's (SSIM) after endoscopic ablation procedures fueled considerable early concerns about the impact of SSIM on the efficacy of endoscopic eradication therapy for cancer prevention (33). However, modern authorities generally have downplayed the importance of SSIM (34), noting that (i) SSIM can be found as frequently or even more frequently in unablated patients than in ablated patients (35,36); (ii) the histologic diagnosis of SSIM can be the spurious result of biopsy processing artifact (37); (iii) when SSIM is found during a course of RFA treatment, it is typically found in areas where Barrett's metaplasia is visible endoscopically (as it often was in our study) and, therefore, it is eliminated by subsequent RFA treatments (36); (iv) the overlying layer of squamous epithelium might protect SSIM from the carcinogenic effects of refluxed acid and bile (38); and, perhaps most importantly, (v) the incidence of cancer development after RFA treatment is very low (26,34).…”

Section: Discussionmentioning

confidence: 99%

An Endoscopic and Histologic Study on Healing of Radiofrequency Ablation Wounds in Patients With Barrett's Esophagus

et al. 2022

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INTRODUCTION: Radiofrequency ablation (RFA) of Barrett's esophagus (BE) inflicts a wound spanning 3 epithelial types (stratified squamous, Barrett's metaplasia, gastric epithelium), yet the esophageal injury heals almost completely with squamous epithelium. Knowledge of how this unique wound heals might elucidate mechanisms underlying esophageal metaplasia. We aimed to prospectively and systematically characterize the early endoscopic and histologic features of RFA wound healing. METHODS:Patients with nondysplastic BE had endoscopy with systematic esophageal photographic mapping, biopsy, and volumetric laser endomicroscopy performed before and at 1, 2, and 4 weeks after RFA. RESULTS:Seven patients (6 men; mean age 56.1 6 10.9 years) completed this study. Squamous re-epithelialization of RFA wounds did not only progress exclusively through squamous cells extending from the proximal wound edge but also progressed through islands of squamous epithelium sprouting throughout the ablated segment. Volumetric laser endomicroscopy revealed significant post-RFA increases in subepithelial glandular structures associated with the squamous islands. In 2 patients, biopsies of such islands revealed newly forming squamous epithelium contiguous with immature-appearing squamous cells arising from esophageal submucosal gland ducts. Subsquamous intestinal metaplasia (SSIM) was found in biopsies at 2 and/or 4 weeks after RFA in 6 of 7 patients.DISCUSSION:RFA wounds in BE are re-epithelialized, not just by squamous cells from the proximal wound margin but by scattered squamous islands in which esophageal submucosal gland duct cells seem to redifferentiate into the squamous progenitors that fuel squamous re-epithelialization. SSIM can be found in most patients during the healing process. We speculate that this SSIM might underlie Barrett's recurrences after apparently successful eradication.

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Section: Discussionmentioning

confidence: 99%

An Endoscopic and Histologic Study on Healing of Radiofrequency Ablation Wounds in Patients With Barrett's Esophagus

et al. 2022

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“…The biology and clinical relevance of subsquamous metaplasia remains unclear. To date, few cases of subsquamous neoplasia have been reported after the successful eradication of BE, the majority of which were associated with ablative therapies other than RFA [11,12]. Titi et al were the first to describe neosquamous neoplasia after the successful RFA of dysplastic BE [6].…”

Section: Discussionmentioning

confidence: 99%

Buried Barrett’s Esophagus with High-Grade Dysplasia after Radiofrequency Ablation

Castela¹,

Serrano²,

Ferro³

et al. 2019

Clin Endosc

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Radiofrequency ablation therapy is an effective endoscopic option for the eradication of Barrett’s esophagus that appears to reduce the risk of esophageal cancer. A concern associated with this technique is the development of subsquamous/buried intestinal metaplasia, whose clinical relevance and malignant potential have not yet been fully elucidated. Fewer than 20 cases of subsquamous neoplasia after the successful radiofrequency ablation of Barrett’s esophagus have been reported to date. Here, we describe a new case of subsquamous neoplasia (high-grade dysplasia) following radiofrequency ablation that was managed with endoscopic resection. Our experience suggests that a meticulous endoscopic inspection prior to and after radiofrequency ablation is fundamental to reduce the risk of buried neoplasia development.

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“…CE‐IM and CE‐D was defined as endoscopic and histological remission of intestinal metaplasia (for CE‐IM) or dysplasia (for CE‐D) on biopsies every 1–2 cm in a four‐quadrant method of the length of the original BE . Our definition of CE‐IM and CE‐D, an accepted standard definition, does not detect subsquamous BE; however, this is of little clinical significance…”

Section: Methodsmentioning

confidence: 99%

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

Trindade

Inamdar

Kothari

et al. 2017

Digestive Endoscopy

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Buried Barrett’s Esophagus—a Sheep in Sheep’s Clothing

Cited by 11 publications

References 12 publications

An Endoscopic and Histologic Study on Healing of Radiofrequency Ablation Wounds in Patients With Barrett's Esophagus

An Endoscopic and Histologic Study on Healing of Radiofrequency Ablation Wounds in Patients With Barrett's Esophagus

Buried Barrett’s Esophagus with High-Grade Dysplasia after Radiofrequency Ablation

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus

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