Clin Endosc.  2023 Mar;56(2):194-202. 10.5946/ce.2022.121.

Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus

• Welsch L
• May A
• Blasberg T
• Wetzka J
• Müller E
• Heilani M
• Friedrich-Rust M
• Knabe M

• KMID: 2540737
• DOI: http://doi.org/10.5946/ce.2022.121

Abstract

Background/Aims
Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.
Methods
Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.
Results
In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.
Conclusions
In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.

Keyword

Barrett’s esophagus; Bile acid sequestrant; Colestyramine; Endoscopic therapy; Recurrence of Barrett’s

Figure

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  Fig. 1. Endoscopic course in one patient. (A) Mucosal adenocarcinoma before the start of therapy (arrow). (B) Fibrin-covered poor healing after endoscopic resection (whitish lesion at 9 o'clock). (C) Healing with neo-Barrett’s (reddish tongue-like area, arrow PE2) under proton pump inhibitor (PPI) and cholestyramine therapy. (D) Complete healing after thermic ablation with PPI and cholestyramine therapy.

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  Fig. 2. A Flowchart showing patients included in this study. ICD-10GM, International Classification of Diseases, 10th Revision, German modification; AC, adenocarcinoma; SCC, squamous cell carcinoma; PPI, proton pump inhibitor; BAS, bile acid sequestrants.

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