Surveillance and surgery for Barrett's esophagus: more results from Sweden. Oberg S, Johansson J, Wenner J, et al. Endoscopic Surveillance of Columnar-Lined Esophagus; Frequency of Intestinal Metaplasia Detection and Impact of Antireflux Surgery Ann Surg 2001;234:619-26

Abstract This study evaluated the prevalence of intestinal metaplasia (IM) in patients with varying lengths of columnar-lined esophagus (CLE) during long-term endoscopic and histopathologic surveillance. A total of 177 patients were followed for a median surveillance period of 5.1 yr and a median four endoscopies per patient. Fifty-two percent of the patients had IM at first surveillance endoscopy. The prevalence of IM increased with increasing number of endoscopies, and after six endoscopies the IM prevalence had increased from ≈30% to ≈64% in patients with a 1–2 cm CLE length, and from ≈45% to ≈89% in those with a 3–4 cm length. IM was found in longer CLE segments early in the surveillance period, whereas detection of IM was evenly spread out over the surveillance period in the short segment patients. A second aim of this study was to compare the effectiveness of antireflux surgery with acid suppressant therapy in preventing the development of IM. Studying patients without IM at the first two endoscopies, the investigators found that IM developed significantly less frequently among the 20 surgically treated patients compared with the 49 medically treated patients (PPI therapy in 45 out of 49). The time to development of IM was shorter in the medically treated group (p = 0.001, log-rank test) and in a multivariable logistic analysis, prior antireflux surgery was the only significant factor associated with a reduced risk of intestinalization (10.3-fold decreased risk).