-
Annals of Medicine Dec 2023Esophageal adenocarcinoma incidence has increased significantly despite surveillance endoscopy for Barrett's esophagus (BE) and gastric acid supression medications. This...
INTRODUCTION
Esophageal adenocarcinoma incidence has increased significantly despite surveillance endoscopy for Barrett's esophagus (BE) and gastric acid supression medications. This prospective, cohort study's aims were to determine the long-term efficacy of proton-pump inhibitors twice daily (PPI-BID) with cryotherapy (CRYO) for complete ablation of BE.
MATERIALS AND METHODS
Consecutive BE patients were managed with a PPI-BID, CRYO ablation, follow-up protocol. Primary outcomes were to determine complete ablation rate of intestinal metaplasia (IM) or dysplasia/carcinoma, and factors affecting recurrence.
RESULTS
Sixty-two patients were enrolled: advanced disease (11%), low-grade or indefinite dysplasia (26%), non-dysplastic BE (63%). In 58 completing CRYO, eradication was confirmed in 100% on surveillance endoscopy. Adverse events (5%) were minor (mild pain 4%). IM recurred in 9% after a mean of 52 months, all successfully re-ablated. No second recurrence occurred. The primary predictor of recurrence was noncompliance with PPI-BID. BE or cardia IM recurred in 35% of those taking proton pump inhibitors once daily or less compared with 0% in those on PPI-BID or dexlansoprazole daily (<.001).
CONCLUSIONS
Minimizing acid reflux with at least PPI-BID combined with CRYO ablation appears to be the optimal cost-effective and safe BE treatment for any stage to minimize progression to adenocarcinoma by addressing both the stimulus that causes BE and the presence of goblet cells.
Topics: Humans; Barrett Esophagus; Proton Pump Inhibitors; Cryosurgery; Cohort Studies; Prospective Studies; Adenocarcinoma
PubMed: 37232568
DOI: 10.1080/07853890.2023.2191002 -
Revista de Gastroenterologia de Mexico 2016Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium.... (Review)
Review
Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.
Topics: Barrett Esophagus; Humans; Risk Factors
PubMed: 26964773
DOI: 10.1016/j.rgmx.2015.07.007 -
World Journal of Gastroenterology Dec 2013To investigate the epidemiology and characteristics of Barrett's esophagus (BE) in China and compare with cases in the west. (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the epidemiology and characteristics of Barrett's esophagus (BE) in China and compare with cases in the west.
METHODS
Studies were retrieved from the China National Knowledge Infrastructure and PubMed databases using the terms "Barrett" and "Barrett AND China", respectively, as well as published studies about BE in China from 2000 to 2011. The researchers reviewed the titles and abstracts of all search results to determine whether or not the literature was relevant to the current topic of this research. The references listed in the studies were also searched. Inclusion and exclusion criteria for the literature were appropriately established, and the data reported in the selected studies were analyzed. Finally, a meta-analysis was performed.
RESULTS
The current research included 3873 cases of BE from 69 studies. The endoscopic detection rate of BE in China was 1%. The ratio of male to female cases was 1.781 to 1, and the average age of BE patients was 49.07 ± 5.09 years. Island-type and short-segment BE were the most common endoscopic manifestations, accounting for 4.48% and 80.3%, respectively, of all cases studied. Cardiac-type BE was observed in 40.0% of the cases, representing the most common histological characteristic of the condition. Cancer incidence was 1.418 per 1000 person-years.
CONCLUSION
Average age of BE patients in China is lower than in Western countries. Endoscopic detection and cancer incidence were also lower in China.
Topics: Adult; Age Distribution; Age Factors; Barrett Esophagus; China; Disease Progression; Esophageal Neoplasms; Esophagoscopy; Female; Humans; Incidence; Male; Middle Aged; Predictive Value of Tests; Sex Distribution; Sex Factors
PubMed: 24379599
DOI: 10.3748/wjg.v19.i46.8770 -
Gastrointestinal Endoscopy Clinics of... Jul 2017Gastroenterology society guidelines recommend endoscopic surveillance as a means to detect early stage cancer in Barrett's esophagus. However, the incidence of... (Review)
Review
Gastroenterology society guidelines recommend endoscopic surveillance as a means to detect early stage cancer in Barrett's esophagus. However, the incidence of esophageal adenocarcinoma in Western countries continues to increase, suggesting that this strategy may be inadequate. Current surveillance methods rely on the endoscopist's ability to identify suspicious areas of Barrett's esophagus to biopsy, random biopsies, and on the histopathologic diagnosis of dysplasia. This review highlights the challenges of using dysplasia to stratify cancer risk and addresses the development and use of molecular biomarkers and in vivo molecular imaging to detect early neoplasia in Barrett's esophagus.
Topics: Adenocarcinoma; Barrett Esophagus; Biomarkers; Biopsy; Esophageal Neoplasms; Esophagoscopy; Humans; Risk; Risk Assessment
PubMed: 28577766
DOI: 10.1016/j.giec.2017.02.003 -
Brain and Behavior Sep 2023The incidence of gastroesophageal reflux disease (GERD) has been shown to be elevated in individuals with epilepsy. Traditional observational studies have led to a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The incidence of gastroesophageal reflux disease (GERD) has been shown to be elevated in individuals with epilepsy. Traditional observational studies have led to a limited understanding of the effects of GERD and BE on epilepsy due to the interference of reverse causation and potential confounders.
METHODS
We conducted a bidirectional two-sample Mendelian randomization (MR) analysis to determine whether GERD and BE can increase the risk of epilepsy. Genome-wide association study data on epilepsy and its subgroups were obtained from the International League Against Epilepsy consortium for primary analysis using three MR approaches and the FinnGen consortium for replication and meta-analysis. We calculated causal estimates between the two esophageal diseases and epilepsy using the inverse-variance weighted method. Sensitivity analysis was conducted to detect heterogeneity and pleiotropy.
RESULTS
We found a potential effect of genetically predicted GERD on the risk of epilepsy (odds ratio [OR] = 1.078; 95% confidence interval [CI], 1.014-1.146, p = .016). Specifically, GERD showed an effect on the risk of generalized epilepsy (OR = 1.163; 95% CI, 1.048-1.290, p = .004) but not focal epilepsy (OR = 1.059, 95% CI, 0.992-1.131, p = .084). Notably, BE did not show a significant causal relationship with the risks of generalized and focal epilepsy.
CONCLUSIONS
Under MR assumptions, our findings suggest a potential risk-increasing effect of GERD on epilepsy, especially generalized epilepsy. Considering the exploratory nature of our study, the association between GERD and epilepsy needs to be confirmed by future prospective studies.
Topics: Humans; Barrett Esophagus; Genome-Wide Association Study; Mendelian Randomization Analysis; Prospective Studies; Case-Control Studies; Gastroesophageal Reflux; Epilepsy; Epilepsy, Generalized
PubMed: 37287440
DOI: 10.1002/brb3.3117 -
Deutsches Arzteblatt International Mar 2015Roughly 3000 new cases of Barrett's carcinoma arise in Germany each year. In view of recent advances in the epidemiology, diagnosis, and treatment of this disease, an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Roughly 3000 new cases of Barrett's carcinoma arise in Germany each year. In view of recent advances in the epidemiology, diagnosis, and treatment of this disease, an update of the clinical recommendations is in order.
METHODS
This review is based on selected relevant publications, including current reviews, meta-analyses, and guidelines.
RESULTS
The risk of progression of Barrett's esophagus to carcinoma lies between 0.10% and 0.15% per year. Risk factors for progression include male sex, age over 50 years, obesity, longstanding and frequent reflux symptoms, smoking, length of the Barrett's esophagus, and intraepithelial neoplasia. Well-differentiated carcinomas that are confined to the esophageal mucosa can be resected endoscopically with a cure rate above 90%. For more advanced, but still locally confined tumors, surgical resection is the treatment of choice. In stages cT3/4, the prognosis can be improved with neo-adjuvant chemo - therapy or combined radiotherapy and chemotherapy. Metastatic Barrett's carcinoma can be treated by endoscopic, chemotherapeutic, radiotherapeutic, and palliative methods.
CONCLUSION
Early carcinoma can often be cured by endoscopic resection. Locally advanced carcinoma calls for multimodal treatment. Current research focuses on means of preventing the progression of Barrett's esophagus, the scope of applicability of endoscopic techniques, and the optimization of multimodal treatment strategies for advanced disease.
Topics: Barrett Esophagus; Causality; Esophageal Neoplasms; Germany; Humans; Precancerous Conditions; Prevalence; Risk Factors
PubMed: 25869347
DOI: 10.3238/arztebl.2015.0224 -
Polski Przeglad Chirurgiczny May 2018The aim of the study was to evaluate the prevalence and clinical aspects of Barrett's esophagus and adenocarcinoma of the lower part of esophagus in gastroscopy.
OBJECTIVE
The aim of the study was to evaluate the prevalence and clinical aspects of Barrett's esophagus and adenocarcinoma of the lower part of esophagus in gastroscopy.
MATERIAL AND METHODS
Retrospective review of 10000 upper gastrointestinal endoscopic examinations were performed at the Department of Oncology Endoscopy in Bydgoszcz from 2004 to 2014 in terms of incidence of Barrett's esophagus and adenocarcinoma in the lower part of esophagus.
RESULTS
The medical records of 5378 (53.8%) women and 4622 (46.2%) men were analyzed. The average age of men and women was 62.4 and 62.7, respectively. Barrett's esophagus was diagnosed in 67 patients, including 38 (56.7%) of men where the average age of men and women was 56.9 and 60.2 years, respectively. The most commonly reported symptom was heartburn occurred in 45 (67.2%) of patients. During ten years of follow-up PB examination the adenocarcinomas were detected in 3 (4.47%) cases. Adenocarcinoma was diagnosed in 46 patients, of whom 37 in men. In the case of 27 patients (58.7%), esophageal cancer was treated with the intention of radicalization. The probability of 5-year survival in these patients was 10.2% for women and 9.2% for men.
CONCLUSIONS
The number of Barrett's esophagus and adenocarcinoma are increasing at 0.67% and 0.46% annually, respectively. The risk of adenocarcinoma developed from Barrett's esophagus during endoscopic follow-up period was 4.47%. Barrett's esophagus is more common in men before the age of 60, and nearly half of them have intestinal metaplasia without dysplasia. Probability of 5-year survival in patients with adenocarcinoma was 9.7%.
Topics: Adenocarcinoma; Aged; Barrett Esophagus; Disease Progression; Esophageal Neoplasms; Female; Gastroesophageal Reflux; Gastroscopy; Humans; Male; Middle Aged; Poland; Retrospective Studies; Survival Analysis
PubMed: 30015321
DOI: 10.5604/01.3001.0011.8166 -
World Journal of Gastroenterology May 2020Radiofrequency ablation (RFA) is very effective for eradication of flat Barrett's mucosa in dysplastic Barrett's esophagus after endoscopic resection of raised lesions.... (Review)
Review
Radiofrequency ablation (RFA) is very effective for eradication of flat Barrett's mucosa in dysplastic Barrett's esophagus after endoscopic resection of raised lesions. However, in a minority of the time, RFA may be ineffective at eradication of the Barrett's mucosa. Achieving complete eradication of intestinal metaplasia can be challenging in these patients. This review article focuses on the management of patients with dysplastic Barrett's esophagus refractory to RFA therapy. Management strategies discussed in this review include optimizing the RFA procedure, optimizing acid suppression (with medical, endoscopic, and surgical management), cryotherapy, hybrid argon plasma coagulation, and EndoRotor resection.
Topics: Antacids; Argon Plasma Coagulation; Barrett Esophagus; Combined Modality Therapy; Cryosurgery; Esophageal Neoplasms; Esophagoscopy; Esophagus; Gastroesophageal Reflux; Humans; Radiofrequency Ablation; Treatment Outcome
PubMed: 32536772
DOI: 10.3748/wjg.v26.i17.2030 -
Clinical Gastroenterology and... Feb 2022A non-endoscopic approach to Barrett's esophagus (BE) surveillance after radiofrequency ablation (RFA) would offer a less invasive method for monitoring. We assessed the...
BACKGROUND & AIMS
A non-endoscopic approach to Barrett's esophagus (BE) surveillance after radiofrequency ablation (RFA) would offer a less invasive method for monitoring. We assessed the test characteristics and cost-effectiveness of the Cytosponge (Medtronic, Minneapolis, MN) in post-RFA patients.
METHODS
We performed a multicenter study of dysplastic BE patients after at least one round of RFA. A positive Cytosponge before endoscopy was defined as intestinal metaplasia (IM) on cytological assessment and/or TFF3 immunohistochemistry. Sensitivity, specificity, and receiver operator characteristic (ROC) curves were calculated. Multivariable regression was used to estimate the odds of a positive Cytosponge in BE. A microsimulation cost-effectiveness model was performed to assess outcomes of various surveillance strategies: endoscopy-only, Cytosponge-only, and alternating endoscopy/Cytosponge.
RESULTS
Of 234 patients, Cytosponge adequately sampled the distal esophagus in 175 (75%). Of the 142 with both endoscopic and histologic data, 19 (13%) had residual/recurrent BE. For detecting any residual Barrett's, Cytosponge had a sensitivity of 74%, specificity of 85%, accuracy of 84%, and ROC curve showed an area under the curve of 0.74. The adjusted odds of a positive Cytosponge in BE were 17.1 (95% CI, 5.2-55.9). Cytosponge-only surveillance dominated all the surveillance strategies, being both less costly and more effective. Cytosponge-only surveillance required <1/4 the endoscopies, resulting in only 0.69 additional EAC cases/1000 patients, and no increase in EAC deaths when compared to currently-practiced endoscopy-only surveillance.
CONCLUSIONS
A positive Cytosponge test was strongly associated with residual BE after ablation. While the assay needs further refinement in this context, it could serve as a cost-effective surveillance examination.
Topics: Barrett Esophagus; Cost-Benefit Analysis; Endoscopy, Gastrointestinal; Esophageal Neoplasms; Esophagoscopy; Humans; Metaplasia
PubMed: 33581357
DOI: 10.1016/j.cgh.2021.02.013 -
Archives of Pathology & Laboratory... Jun 2010Classic pathology teaching emphasizes that neoplastic lesions of the gastrointestinal tract are characterized by architectural and cytologic abnormalities that... (Review)
Review
CONTEXT
Classic pathology teaching emphasizes that neoplastic lesions of the gastrointestinal tract are characterized by architectural and cytologic abnormalities that distinguish it from normal tissue. Recent studies suggest that many important-and in some cases clonal-molecular abnormalities that lead to dysregulation of cell proliferation and differentiation (neoplasia) occur before morphologic expression of dysplasia.
OBJECTIVE
To summarize the biologic and pathologic features of preneoplastic conditions of the tubal gut that reveal evidence of neoplastic alteration, but without the traditional morphologic features of dysplasia, in order to provide guidance on how to identify these lesions. Particular attention is given to Barrett esophagus, a chronic inflammatory condition in which early molecular and morphologic events that drive carcinogenesis are best understood.
DATA SOURCES
Selected references and abstracts were obtained by a PubMed (US National Library of Medicine) search by using the search headings neoplasia, preneoplasia, dysplasia, adenoma, serrated polyps, and Barrett's esophagus between the years 1980 and 2009.
CONCLUSIONS
Many types of lesions throughout the tubal gut fulfill the most basic and classic principles of a neoplastic precursor lesion but lack conventional morphologic evidence of dysplasia and/or maintain the capacity for cell differentiation and maturation. All of these lesions, such as squamous dysplasia of the esophagus, dysplasia in Barrett esophagus, and hyperplastic/serrated polyps of the colon, represent early neoplastic precursor lesions but without conventional histologic features of dysplasia. It is important for pathologists to be aware of these lesions, both for diagnostic and prognostic purposes, but also so that future studies can be performed with regard to risk stratification of patients.
Topics: Barrett Esophagus; Cell Proliferation; Cell Transformation, Neoplastic; Disease Progression; Gastrointestinal Neoplasms; Humans; Precancerous Conditions; Prognosis
PubMed: 20524867
DOI: 10.5858/134.6.896