NEW YORK (Reuters Health) – Endoscopic ablation of Barrett’s esophagus can bury metaplastic glands under a layer of neosquamousepithelium. However, how often this happens and its importance still is uncertain, researchers report in an August 9th on-line paper in The American Journal of Gastroenterology.
Dr. Stuart Jon Spechler of Dallas VA Medical Center, Texas and colleagues note that if an ablation procedure does not destroy all of the metaplastic epithelium it may heal buried in the lamina.
This “buried metaplasia” Dr. Spechler told Reuters Health by email, “may have malignant potential and, therefore, it is important to know how often endoscopic ablation results in buried metaplasia before adopting a policy of endoscopic ablation for all patients with Barrett’s esophagus.”
To explore the frequency and importance of such outcomes, the researchers examined the literature and found 40 articles that met their inclusion criteria.
They identified 9 articles describing 34 patients with neoplasia appearing in buried metaplasia. Of these, 31 followed photodynamic therapy (PDT) and the remaining 3 were found after argon plasma coagulation or laser ablation.
The team also found 5 studies covering the prevalence of buried metaplasia before ablation. This ranged from none to 28%.
In 22 reports on PDT for 953 patients, buried metaplasia was foundin 135 (14.2 %). In 18 reports on radiofrequency ablation (RFA) in 1004 patients, buried metaplasia was found in only 9 (0.9 %).
However, say the investigators, “none of the reports described specifically whether biopsy specimens of neosquamous epithelium contained sufficient subepithelial lamina propria to be informative for the evaluation of buried metaplasia.”
Buried metaplasia, continued Dr. Spechler, “is reported less frequently after RFA than after other endoscopic ablation techniques like photodynamic therapy. However, we also concluded that 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.”
Reference:
Buried Metaplasia After Endoscopic Ablation of Barrett’s Esophagus: A Systematic Review
Am J Gastroenterol 2011.
