Esophagogastric junction biopsy may be forgone after endoscopic eradication of BE

Random histological sampling from the esophagogastric junction (EGJ) appears to hold low clinical relevance in patients who have undergone successful endoscopic eradication of all visible Barrett’s esophagus (BE), given that the incidence of intestinal metaplasia at the EGJ does not pose a higher risk of disease recurrence, according to a study.

The study used data from the Dutch registry and included patients with successful endoscopic eradication therapy (EET) for early BE neoplasia. Researchers evaluated the incidence of intestinal metaplasia at the EGJ and estimated the relationship between intestinal metaplasia and visible (dysplastic) BE recurrence.

A total of 1,154 patients were included in the analysis. The median follow-up was 43 months, with each patient having a median of four follow-up endoscopies. Dysplasia recurrence occurred in 38 patients (3 percent; annual risk, 1.0 percent), while neoplasia recurred in 24 patients (2 percent; annual risk, 0.7 percent).

Persisting intestinal metaplasia at the EGJ was detected in 78/1,154 patients (7 percent) after eradication therapy and in 42/78 patients (46 percent) during further follow-up. There were no significant association seen between persisting intestinal metaplasia at the EGJ at eradication therapy and recurrent nondysplastic BE (hazard ratio [HR], 1.15, 95 percent confidence interval [CI], 0.63–2.13) or dysplastic BE (HR, 0.73, 95 percent CI, 0.17–3.06).

Among the 1,043 patients (90 percent) with no intestinal metaplasia at the EGJ at the time of eradication therapy, intestinal metaplasia occurred in 72 patients (7 percent) after a median of 21 months and in 19 patients during further follow-up.

Recurrent intestinal metaplasia at the EGJ showed no association with nondysplastic (HR, 1.18, 95 percent CI, 0.67–2.06) or dysplastic recurrence (HR, 0.27, 95 percent CI, 0.04–1.96).