Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel

Duits, Lucas C.; Phoa, K. Nadine; Curvers, Wouter L.; Kate, Fiebo J.W. ten; Meijer, Gerrit A.; Seldenrijk, Cees A.; Offerhaus, G. Johan A.; Visser, Mike; Meijer, Sybren L.; Krishnadath, Kausilia K.; Tijssen, Jan G.P.; Mallant-Hent, Rosalie C.; Bergman, Jacques

doi:10.1136/gutjnl-2014-307278

Cited by 247 publications

(212 citation statements)

References 38 publications

Supporting

Mentioning

193

Contrasting

Unclassified

Order By: Relevance

“…Review by two GI pathologists, with extensive experience in the diagnosis of BE-related neoplasia, found that of 147 patients diag nosed with LGD in the community, 85% of the patients were downgraded to a diagnosis of no dysplasia ( 122 ). Further work by that group examined 293 additional patients with LGD diagnosed in the community who had biopsies reviewed by at least 2 GI pathologists and 73% of the cases were downgraded to indefinite for dysplasia or nondysplastic BE ( 123 ). Other studies suggest that community-based pathologists have diffi culties in the interpretation of both nondysplastic BE and dysplasia ( 124 ).…”

Section: Advanced Endoscopic Imaging Techniquesmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,355

1,412

View full text Add to dashboard Cite

Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

show abstract

Section: Advanced Endoscopic Imaging Techniquesmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,355

1,412

View full text Add to dashboard Cite

show abstract

“…intra-observer variability and variable outcomes 12 , so including them in the model from the start could cause confounding. We therefore analysed them separately.…”

Section: Low Grade Dysplasia (Lgd) Is a Difficult Histopathological Dmentioning

confidence: 99%

Risk stratification of Barrett's oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study

Ross-Innes

Chettouh

Achilleos

et al. 2017

The Lancet Gastroenterology & Hepatology

View full text Add to dashboard Cite

show abstract

“…29 Similarly to the aforementioned study, they demonstrated that only a small percentage (27%) of the original LGD diagnoses were confirmed, while the remaining 73% of cases were down-staged. After a median follow-up of 39 months the risk of progression to HGD or OAC was 9.1% per patient-year in the confirmed LGD group.…”

Section: Presence Of Lgdmentioning

confidence: 59%

Endoscopic risk factors for neoplastic progression in patients with Barrett’s oesophagus

2016

View full text Add to dashboard Cite

Barrett's oesophagus is a precursor lesion for oesophageal adenocarcinoma, which generally has a poor prognosis. Patients diagnosed with Barrett's oesophagus therefore undergo regular endoscopic surveillance to detect neoplastic lesions at a curable stage. The efficacy of endoscopic surveillance of Barrett's oesophagus patients is, however, hampered by difficulties to detect early neoplasia endoscopically, biopsy sampling error, inter-observer variability in histological assessment and the relatively low overall progression rate. Efficacy and cost-effectiveness of Barrett's surveillance may be improved by using endoscopic and clinical characteristics to risk-stratify Barrett's patients to high-and low-risk categories. Recent national and international surveillance guidelines have incorporated Barrett's length and presence of low-grade dysplasia in the advised surveillance intervals. In this review we will discuss endoscopic characteristics that may be associated with neoplastic progression in Barrett's oesophagus and that may be used to tailor surveillance in Barrett's patients.

show abstract

Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel

Cited by 247 publications

References 38 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Risk stratification of Barrett's oesophagus using a non-endoscopic sampling method coupled with a biomarker panel: a cohort study

Endoscopic risk factors for neoplastic progression in patients with Barrett’s oesophagus

Contact Info

Product

Resources

About