Care of the Postablation Patient

Endoscopic eradication therapy is effective and durable for the treatment of Barrett’s esophagus (BE), with low rates of recurrence of dysplasia but significant rates of recurrence of intestinal metaplasia. Identified risk factors for recurrence include age and length of BE before treatment and may also include presence of a large hiatal hernia, higher grade of dysplasia before treatment, and history of smoking. Current guidelines for surveillance following ablation are limited, with recommendations based on low-quality evidence and expert opinion. New modalities including optical coherence tomography and wide-area tissue sampling with computer-assisted analysis show promise as adjunctive surveillance modalities.

Key points

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Endoscopic eradication therapy is effective and durable for the treatment of Barrett’s esophagus (BE), with low rates of recurrence of dysplasia but significant rates of recurrence of intestinal metaplasia.
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Identified risk factors for recurrence include age and length of BE before treatment and may also include presence of a large hiatal hernia, higher grade of dysplasia before treatment, and history of smoking.
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Current guidelines for surveillance following ablation are limited, with recommendations based on low-quality evidence and expert opinion.
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Limitations to current postablation surveillance protocols include lack of standardized definitions and endpoints, variability in treatments used, sampling error, and interobserver variability.
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New modalities including optical coherence tomography and wide-area tissue sampling with computer-assisted analysis show promise as adjunctive surveillance modalities.