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A Practical Approach to Refractory and Recurrent Barrett's Esophagus
Domenico A Farina1, Ashwinee Condon2, Srinadh Komanduri1
1Department of Gastroenterology and Hepatology, Northwestern University, 676 North St. Clair Street, Arkes Pavilion Suite 1400, Chicago, IL 60611, USA.
Gastrointestinal Endoscopy Clinics of North America
|November 20, 2020
Summary
Endoscopic eradication therapy (EET) can eliminate Barrett's esophagus (BE) neoplasia. Refractory or recurrent BE after EET requires further management, potentially including salvage therapy.
Area of Science:
- Gastroenterology
- Endoscopy
- Oncology
Background:
- Barrett's esophagus (BE) with neoplasia is treated with endoscopic eradication therapy (EET).
- EET is effective for complete eradication of intestinal metaplasia (CE-IM).
- Refractory or recurrent BE after EET can occur.
Purpose of the Study:
- To discuss management strategies for refractory or recurrent BE after EET.
- To highlight the importance of optimizing reflux control.
- To consider salvage EET with alternative modalities.
Main Methods:
- Review of current literature and clinical guidelines.
- Discussion of diagnostic approaches for refractory BE.
- Consideration of therapeutic options beyond standard EET.
Main Results:
- Refractory BE is defined by lack of improvement after <= 3 ablative sessions.
- Recurrence of intestinal metaplasia post-EET is a recognized challenge.
- Esophageal manometry and optimized antireflux strategies are key interventions.
Conclusions:
- Management of refractory or recurrent BE requires a tailored approach.
- Optimizing gastroesophageal reflux disease (GERD) control is crucial.
- Salvage EET may be necessary for patients failing standard therapy.
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