Abstracts
2002 Digestive Disease Week

# 102662 Abstract ID: 102662 High Prevalence of Intestinal Metaplasia at the Gastro-Esophageal Junction in End-Stage Achalasia
Andrea Gattolin, Jeffrey H Peters, Jeffrey A Hagen, Nagammapudur S Balaji, Richard Gurski, Laura Antoniazzi, Dimitrios Theodorou, Cedric G Bremner, Peter F Crookes, Steven Demeester, Tom Demeester, LOS ANGELES, CA

Background: The treatment of achalasia is a balance between releiving esophageal outflow obstruction and inducing gastro esophageal reflux (GER). Long-term studies have provided conflicting reports of the prevalence of GER following balloon dilation or surgical myotomy. We have recently noted that unrecognized intestinal metaplasia (IM) is common in esophagectomy specimens of patients with end-stage achalasia. Aim: To determine the prevalence of intestinal metaplasia at the gastro esophageal junction in end-stage achalasia. Methods: Twenty-nine patients with end-stage achalasia underwent esophagectomy for persistent dysphagia and regurgitation. There were 21 males and 8 females with a median age 51 years. Clinical features, previous treatment, endoscopic findings and specimen histopathology were retrospectively reviewed. Results: Previous treatment includes surgical myotomy alone in 7 patients, multiple pneumatic dilatation in 9 and both in 7. The remaining 6 patients has either dilatation or myotomy prior to esophagectomy. Intestinal metaplasia was present in 8/29 (27.5%) of the surgical specimens. Only two of the eight had endoscopic evidence of a columnar lined esophagus prior to esophagectomy, one of which was 6 cm in length. Seven of these eight patients had a previous surgical myotomy at a median of 8 years prior to esophagectomy. Five of these did not have a concomitant antireflux procedure and two had a redo myotomy. One patient who did not have a myotomy developed IM 9 years after diagnosis. There was no statistical difference in the median time after myotomy for patients with (7/14) and without (6/14) IM and in patients treated or not with proton pump inhibitor (p=0.9). The incidence of IM after surgery was significantly more common (p<0.014). Conclusions: There is a high prevalence of intestinal metaplasia in esophagectomy specimens of patients with end-stage achalasia, particularly so in patients having surgical myotomy without any reflux protection. The data suggest that endoscopic surveillance for the complications of gastroesophageal reflux may be warranted in patients following treatment for achalasia.