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Prevalence and Natural History of Barrett's Esophagus in Lung Transplant: A Single-Center Experience.

BACKGROUND: Barrett's esophagus (BE)-intestinal metaplasia in the esophagus-may progress to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and ultimately, invasive esophageal adenocarcinoma (EAC). The course of BE in immunosuppressed lung transplant recipients is unknown.

METHODS: We retrospectively reviewed the records of patients who underwent lung transplant at our center between 01/01/2010 and 10/31/2016. We analyzed pre-transplant esophagram, esophagogastroduodenoscopy, 24-hour pH monitoring, high-resolution manometry, and gastric emptying studies.

RESULTS: Of the 466 patients who underwent transplantation during the study period, 54 (11.59%) had BE on pre-transplant esophagogastroduodenoscopy. Of these, one patient had HGD pre-transplant. Median patient age was 64 years (interquartile range [IQR], 58.25-68.75) ; 66.6% were men. Median follow-up duration was 29.48 months (IQR, 19.69-37.98). 16/54 patients (29.62%) underwent antireflux surgery posttransplant. Three patients developed LGD or EAC during posttransplant surveillance. One patient was diagnosed with HGD 24 months after retransplant. She underwent complete endoscopic ablation and was dysplasia-free for 5 months, but ultimately recurred and underwent esophagectomy for invasive cancer. Two patients were diagnosed with LGD 7 and 13 months after transplant and were successfully treated with radiofrequency ablation. The rate of progression to dysplasia or EAC was 2.3% per patient-year.

CONCLUSIONS: BE seems to be more prevalent in lung transplant recipients than in the general population. Our findings suggest that patients with BE have higher risk of BE-to-EAC progression after lung transplant, and that HGD may progress rapidly in immunosuppressed patients. More intensive surveillance endoscopy may be required in patients with BE after lung transplant.

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