Progression of esophageal atresia associated Barrett’s esophagus in adulthood – Is endoscopic surveillance worth it?

OBJECTIVES: Barrett's esophagus (BE) is a late sequela after esophageal atresia (EA) repair. In order to assess the need for an endoscopic BE surveillance program, we studied evolution of BE in 71 adults with C-type EA in two successive endoscopies. METHODS: Endoscopic Prague Classification of BE was used. Endoscopic BE was graded as True BE (with goblet cell metaplasia) or BE without goblet cell metaplasia. RESULTS: The median patient age was 36 (IQR 28-43) years at E1 (index endoscopy) and 50 (41-58) years at E2 (follow-up endoscopy) with median interval of 16 (12-17) years. Prevalence of endoscopic BE increased from 15 % to 42 % (p = 0.002) and of true BE from 1.4 % to 15 %, (p = 0.04). Dysplasia and cancer were not observed. De novo true BE (n = 10) developed from previous BE without goblet cell metaplasia (n = 4) or from normal epithelium (n = 6). In four (5.6 %) patients true BE extended ≥ 3 cm. True BE was predicted by previous endoscopic BE (RR = 9.2; 95%CI 2.0-4-1, p = 0.004) and esophagitis (RR = 5.8; 95%CI 1.4-38, p = 0.02). CONCLUSIONS: The prevalence of endoscopic and true BE increased by 3- and 10-fold, respectively, between median ages of 36 and 50 years. High-risk BE was rare and no dysplasia or cancer was found. Esophagitis and endoscopic BE predisposed to true BE. Endoscopic surveillance of patients with EA before the age 50 years seems unnecessary.