Barrett's Esophagus and Adenocarcinoma Risk

Rugge, Massimo; Zaninotto, Giovanni; Parente, Paola; Zanatta, Lucia; Cavallin, Francesco; Germanà, B.; Macrì, Ettore; Galliani, E.; Iuzzolino, P.; Ferrara, Francesco; Marin, R.; Nisi, Emiliano; Iaderosa, Gaetano Antonio; Deboni, Michele; Bellumat, Angelo; Valiante, F.; Florea, G; Libera, Duilio Della; Benini, M.C.; Bortesi, Laura; Meggio, Alberto; Zorzi, Maria Grazia; Depretis, G.; Miori, G.; Morelli, Luca; Cataudella, Giovanni; d'Amore, Emanuele S G; Franceschetti, Ilaria; Bozzola, L.; Paternello, Elisabetta; C, Antonini; Mario, F. Di; Bò, N. Dal; Furlanetto, Alberto; Norberto, Lorenzo; Polese, Lino; Iommarini, Silvia; Farinati, Fabio; Battaglia, Giorgio; Diamantis, G.; Realdon, Stefano; Guido, Ennio; Mastropaolo, G; Canova, Daniele; Guerini, A.; Franceschi, Marilisa; Zirillo, Maurizio

doi:10.1097/sla.0b013e3182737a7e

Cited by 46 publications

(9 citation statements)

References 32 publications

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“…13,14 In addition, 3 multicentre studies consistently showed the relative risk of length (per centimeter) on progression to EAC on multivariant analysis as 1.1 to 1.21. 15–17 According to these findings, the dominancy of patients with short-segment BE in our series is supporting our recommendation against performing a second endoscopic evaluation.…”

Section: Discussionsupporting

confidence: 82%

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy

et al. 2016

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At present, we do not know the exact prevalence of Barrett esophagus (BE) developing later in patients without BE in their first endoscopic screening. The purpose of this study was to determine the prevalence of BE on the second endoscopic examination of patients who had no BE in their first endoscopic examination.The data of the patients older than 18 years who had undergone upper gastrointestinal system endoscopy more than once at the endoscopy unit of our clinic during the last 6 years were retrospectively analyzed.During the last 6 years, 44,936 patients had undergone at least one endoscopic examination. Among these patients, 2701 patients who had more than one endoscopic screening were included in the study. Of the patients, 1276 (47.3%) were females and 1425 (52.7%) were males, with an average age of 54.9 (18–94) years. BE was diagnosed in 18 (0.66%) of the patients who had no BE in the initial endoscopic examination. The patients with BE had reflux symptoms in their medical history and in both endoscopies, they revealed a higher prevalence of lower esophageal sphincter laxity, hiatal hernia, and reflux esophagitis when compared to patients without BE (P < 0.001).Our study showed that in patients receiving no diagnosis of BE on their first endoscopic examination performed for any reason, the prevalence of BE on their second endoscopy within 6 years was very low (0.66%).

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Section: Discussionsupporting

confidence: 82%

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy

et al. 2016

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“…2,3,9,19–42 Twenty-four of these studies cumulatively reported 320 missed EAC and 500 incident EAC, and 20 studies reported the combined end points of HGD-EAC with 638 missed HGD-EAC and 863 incident HGD-EAC (Table 1). Twelve studies were excluded from meta-analysis due to overlapping cohorts.…”

Section: Resultsmentioning

confidence: 99%

“…Mean/median follow-up was ≥5 years in 12 studies, including ≥8 years in 4 studies. Four studies were population-based (median follow-up, 5.0 years), 2,3,9,21 4 were multicenter studies (median follow-up, 4.7 years), 27,29,39,42 and the remaining were single-center studies (median follow-up, 4.8 years). 19,20,22–26,28,30–38,40,41 Most studies reported or permitted a missed vs incident cutoff of exactly 12 months to be applied, with the exception of 2 studies reporting cutoffs of 9 and 6 months, 32,39 and 1 study for which only a cutoff of 14 months could be applied.…”

Section: Resultsmentioning

confidence: 99%

Magnitude of Missed Esophageal Adenocarcinoma After Barrett’s Esophagus Diagnosis: A Systematic Review and Meta-analysis

et al. 2016

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Background & Aims A proportion of patients with Barrett's esophagus (BE) are diagnosed with esophageal adenocarcinoma (EAC) within 1 year of an endoscopic examination that produced negative findings. These cases of missed cancers have not been well studied, despite current surveillance strategies for BE. We performed a systematic review and meta-analysis to determine the magnitude of missed EAC in cohorts of patients with BE. Methods We searched MEDLINE, EMBASE, and Web of Science from their inception to May 31, 2015 to identify cohort studies of adults with BE (baseline nondysplastic BE ± BE with low-grade dysplasia) and at least a 3-year follow-up period, providing data on missed and incident EACs (diagnosed within 1 year and diagnosed more than 1 year after the initial endoscopy in which BE was diagnosed, respectively). The main outcome measure was pooled proportion of missed and incident EACs (of all EACs detected after initial endoscopy) among BE cohorts, using a random effects model. Results In a metaanalysis of 24 studies reporting on 820 missed and incident EACs, 25.3% were classified as missed (95% confidence interval: 16.4%–36.8%) and 74.7% as incident EACs (95% CI: 63.2%–83.6%), although there was substantial heterogeneity among studies (I2 = 74%). When the analysis was restricted to nondysplastic BE cohorts (15 studies), 23.9% of EACs were classified as missed (95% confidence interval: 15.3%–35.4%; I2 = 0%). In a meta-analysis of 10 studies with follow-up periods of ≥5 years (a total of 239 EACs), 22.0% were classified as missed (95% confidence interval: 8.7%–45.5%), with substantial heterogeneity (I2 = 68%). Conclusions Among adults with nondysplastic BE (or BE with low-grade dysplasia) at their index endoscopy and at least a 3-year follow-up period, 25% of EACs are diagnosed within 1 year after the index endoscopy. Additional resources should be allocated to detect missed EAC.

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“…All the histopathological samples were retrospectively collected (2006-2015) from the files of the Surgical Pathology Unit of the Department of Medicine (DIMED) at the University of Padua and from the Veneto Region's multicenter Barrett Esophagus Registry (EBRA, Padua Unit) [41]. Investigation has been conducted in accordance with the ethical standards, according to national and international guidelines, and has been approved by the authors’ institutional review board (418/04/CE).…”

Section: Methodsmentioning

confidence: 99%

Squamous cell carcinoma antigen (SCCA) is up-regulated during Barrett’s carcinogenesis and predicts esophageal adenocarcinoma resistance to neoadjuvant chemotherapy

et al. 2016

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Squamous Cell Carcinoma Antigen (SCCA) is consistently overexpressed in many different solid tumors, and has been associated with both tumor aggressiveness and chemoresistance. No data, however, is currently available on SCCA expression during esophageal Barrett's carcinogenesis, nor on SCCA expression's role on esophageal adenocarcinoma chemoresistance. The SCCA immunohistochemical expression was assessed in a series of 100 biopsy samples covering the whole histological spectrum of Barrett's oncogenesis. Squamous native mucosa was characterized by a moderate to strong cytoplasmic and nuclear SCCA expression in suprabasal, medium, and superficial layers. On the other hand, almost half of the considered lesions did not express SCCA; the other half featured weak to moderate SCCA expression. The relationship between SCCA protein expression and tumor response to neoadjuvant chemotherapy was assessed in 90 esophageal adenocarcinoma specimens (40 biopsy and 50 surgery specimens), stratified according to Mandard tumor regression grade. As observed in other settings, the presence of SCCA expression clustered in the group of tumors characterized by a lower responsiveness to neoadjuvant treatments. The present results suggest an involvement of SCCA in a subset of Barrett-related tumors, and prompt to consider the SCCA-protein expression as response-predictive marker of neoadjuvant therapy in esophageal adenocarcinomas.

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Barrett's Esophagus and Adenocarcinoma Risk

Abstract: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

Cited by 46 publications

References 32 publications

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy

Magnitude of Missed Esophageal Adenocarcinoma After Barrett’s Esophagus Diagnosis: A Systematic Review and Meta-analysis

Squamous cell carcinoma antigen (SCCA) is up-regulated during Barrett’s carcinogenesis and predicts esophageal adenocarcinoma resistance to neoadjuvant chemotherapy

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