Prevalence of Barrett Esophagus in Adolescents and Young Adults With Esophageal Atresia

Objectives: To study the prevalence of Barrett esophagus (BE) (gastric and/or intestinal metaplasia) in adolescents treated for esophageal atresia (EA). Methods: This multicentric, prospective study included patients 15 to 19 year-old with medical history of EA. An upper endoscopy with standardized esophageal staged biopsies (at least 12) under general anesthesia was performed. Histological suspicion of metaplasia benefited from a centralized confirmation. Results: 120 patients aged 16.5 years (Â ± 1.4) were included. At evaluation, 8% had denutrition, 41% had an anti-reflux surgery performed and 41% had GERD symptoms with only 28% under medical treatment. Esophagitis was found at endoscopy in 34% and confirmed at histology in 67%. Endoscopy suspected BE in 37%, confirmed at histology in 43% (50 gastric and 1 intestinal). No endoscopic nor histological anomalies were found at the anastomosis. No significant relationships were found between BE and clinical symptoms. Multivariate analysis showed that BE was associated to EA without fistula (p = 0.03; OR = 0.21 [0.05–0.87]); previous multiple antireflux surgery (p = 0.04; OR = 3.29 [1.08–10.07]); BE suspicion at endoscopy (p < 0.001; OR = 0.04 [0.01–0.18]); histological esophagitis (p = 0.02; OR = 0.17 [0.04–0.73]). Conclusions: Patients with EA are at high risk of persistent GERD and BE. Long-time systematic follow-up of the esophageal mucosa including multistaged biopsies is therefore required even in asymptomatic patients.