Utility of Random Neo-Squamous and Cardia Biopsies During Surveillance After Dysplastic Barrett's Eradication: A Prospective Single- Center Study.

Abstract

Background and aims: Surveillance post complete eradication of dysplastic Barrett's esophagus (BE) is important given the risk of recurrent intestinal metaplasia and neoplasia, however the optimal surveillance strategy remains unclear. This study aims to ascertain the yield of random biopsies of the neo-squamous epithelium (NE) and gastric cardia for detecting dysplasia.

Methods: In this prospective single-center study, patients undergoing post-endoscopic eradication therapy (EET) surveillance for dysplastic BE were included. High-definition white light, narrow-band, and near-focus imaging were used for esophageal assessment. Targeted biopsies were performed on visible abnormalities, followed by six random cardia biopsies and four-quadrant NE biopsies at 1 cm intervals.

Results: Seventy-one patients underwent 119 surveillance endoscopies after complete eradication of intestinal metaplasia (CEIM), yielding 2,892 biopsies (66 targeted, 714 random cardia, 2,112 NE). Targeted biopsies detected IM in 15.2% (10/66) and dysplasia in 3% (2/66) of biopsies, leading to further treatment in 8 patients. In contrast, IM was detected in 2.4% (17/714) of random cardia biopsies and 0.4% (9/2112) of random NE biopsies. No dysplasia was detected via random cardia or NE biopsies. The total cost to detect one case of IM via random biopsies was $3,144, whereas the cost to detect one case of dysplasia using the random biopsy strategy exceeded $29,673.

Conclusions: Targeted biopsies of the NE and gastric cardia are important in detecting early BE recurrence. Additional random NE and cardia biopsies provide no added benefit in dysplasia detection but incur unnecessary time and cost expenditures. We recommend targeted biopsies as the primary surveillance strategy post-CEIM and eliminating random biopsies in expert centers.