Should antireflux surgery be considered after successful endoscopic treatment of Barrett’s esophagus with dysplasia and early cancer?

We read with interest the article by Haidry et al. [1] entitled “Comparing outcome of radiofrequency ablation in Barrett’s with high grade dysplasia and intramucosal carcinoma: a prospective multicenter UK registry,” which was published recently in Endoscopy. The UK registry data support the effectiveness and superiority of radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) for the management of Barrett’s esophagus containing high grade dysplasia and early cancer. The study therefore confirms other recent observations that have shown the benefits of RFA for the treatment of Barrett’s esophagus [2] [3], the morphologic complication of gastroesophageal reflux disease (GERD) [2] [4].

Barrett’s esophagus results from increased gastroesophageal reflux, which fosters the development of columnar-lined esophagus, intestinal metaplasia, dysplasia, and cancer [1] [2] [3] [4]. After successful RFA therapy, patients are usually kept on high dose proton pump inhibitor (PPI) therapy [2] [3], which reduces acidity, but not reflux per se. As a consequence the esophageal tissue continues to be exposed to nonacidic gastric reflux, which may encourage the genetic switch towards dysplasia and cancer. It therefore seems justified to consider esophageal function tests to assess whether individuals might benefit from the elimination of reflux by laparoscopic antireflux surgery after EMR and RFA [2] [5].

We congratulate the authors for their great report and ask them kindly to address the above issue.

• References

• 1 Haidry RJ, Lipman G, Banks MR et al. Comparing outcome of radiofrequency ablation in Barrett’s with high grade dysplasia and intramucosal carcinoma: a prospective multicenter UK registry. Endoscopy [Epub ahead of print 2015 June 30] DOI: DOI: 10.1055/s-0034-1392414.
• 2 Arora G, Basra SS, Roorda AK et al. Radiofrequency ablation of Barrett’s esophagus. Eur Surg 2009; 41: 19-25
• 3 van Vilsteren FG, Alvarez Herrero L, Pouw RE et al. Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett’s esophagus with early neoplasia: a prospective multicenter study. Endoscopy 2013; 45: 516-525
• 4 Alvarez Herrero L, Curvers WL, van Vilsteren FG et al. Validation of the Prague C&M classification of Barrett’s esophagus in clinical practice. Endoscopy 2013; 45: 876-882
• 5 Rodriguez L, Rodriguez P, Gomez B et al. Long-term results of electrical stimulation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease. Endoscopy 2013; 45: 595-604