A0193 - A Clinical Dilemma: Surveillance of Barrett’s Esophagus in the Face of Concurrent Esophageal Varices

Colin Hartgerink, BS¹, Faisal M. Nimri, MBBS², Tobias Zuchelli, MD², Cyrus Piraka, MD², Syed-Mohammed Jafri, MD^3
1Wayne State University School of Medicine, Detroit, MI; ²Henry Ford Hospital, Detroit, MI; ³Henry Ford Health System, Detroit, MI

Introduction: The diagnosis and management of non-dysplastic, dysplastic, and neoplastic Barrett’s esophagus (BE) can be complicated by the presence of esophageal varices (EV). Due to the bleeding risk associated with esophageal varices, biopsies of suspected BE can be challenging to obtain. As a result, patients with both varices and BE may not receive adequate surveillance of their Barrett’s esophagus and may be at an increased risk for esophageal adenocarcinoma.

Methods: This is a retrospective chart review to analyze whether patients with Barrett’s esophagus and concurrent esophageal varices received adequate surveillance of BE related pathology. ICD 10 codes were used to extract data from 2010-2021 for patients who had concurrent diagnoses of both BE and esophageal varices. Outcomes analyzed included whether biopsies were obtained in diagnosis and surveillance of BE, and the development of dysplasia and/or esophageal adenocarcinoma.

Results: A total of 12 patients were included in the cohort. The mean age of patients was (63.8 ± 9.7) years and 75% (9/12) were male. An equal number of patients had long segment and short segment BE. The majority of the cohort had large EV (75%). Only 5 (41.7%) of the 12 patients with EV and BE received adequate surveillance. In the 5 cases, biopsies were obtained to confirm the diagnosis of BE and routine endoscopic surveillance of BE was performed every 3-5 years with repeat biopsies. The remaining 7 patients did not receive adequate surveillance of BE as described in Table 1. Of these 7 cases without adequate surveillance, 2 patients never had biopsies from the suspected BE due to bleeding concerns. One patient had an initial biopsy confirming BE but insufficient surveillance biopsies due to bleeding risk. Two cases (cases #6 and #7) developed advanced pathology (high grade dysplasia and invasive esophageal adenocarcinoma) with 1 resulting death from esophageal cancer.

Discussion: In summary, this small study of 12 patients with BE and EV suggests that endoscopic surveillance may not be prioritized in the setting of varices. As a subset of these patients may still develop dysplasia and even adenocarcinoma, decision-making in this setting should weigh the relative risks of surveillance endoscopy and biopsies versus a more conservative approach. Two of these patients without adequate surveillance developed advanced pathology. This study highlights the importance and difficulty in providing adequate endoscopic surveillance in patients with BE and EV.



Disclosures:


Colin Hartgerink, BS¹, Faisal M. Nimri, MBBS², Tobias Zuchelli, MD², Cyrus Piraka, MD², Syed-Mohammed Jafri, MD³. A0193 - A Clinical Dilemma: Surveillance of Barrett’s Esophagus in the Face of Concurrent Esophageal Varices, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.