Development of Subsquamous High-Grade Dysplasia and Adenocarcinoma After Successful Radiofrequency Ablation of Barrett's Esophagus

Titi, Mohammad; Overhiser, Andrew; Ulusaraç, Ozlem; Falk, Gary W.; Chak, Amitabh; Wang, Kenneth; Sharma, Prateek

doi:10.1053/j.gastro.2012.04.051

Cited by 117 publications

(71 citation statements)

References 13 publications

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“…Despite concerns regarding depth of biopsies aft er ablation, the prevalence of subsquamous BE is variable aft er ablation, with rates ranging from 0.9% aft er RFA to 14.2% aft er photodynamic therapy ( 181 ). Imaging techniques such as optical coherence tomography suggest a higher prevalence of subsquamous BE, particularly at the GEJ ( 182 ), but the signifi cance of this is unclear, despite case reports of subsquamous EACs arising aft er ablation ( 175 ). Some studies suggest that surveillance biopsies obtained aft er ablation may be too superfi cial to detect subsquamous BE, with most biopsies not containing lamina propria ( 183 ).…”

Section: Management Of Be After Endoscopic Therapymentioning

confidence: 99%

“…Th ough most recurrences are nondysplastic, up to a quarter may be dysplastic, including EAC ( 164,175 ). Variability in reported recurrence rates may be partially explained by diff erences in defi nitions of recurrence among studies: with some studies reporting recurrences located only in the tubular esophagus ( 176 ), whereas others reporting recurrent IM in both the esophagus and the GEJ/cardia ( 177 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,356

1,412

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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 ...

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Section: Management Of Be After Endoscopic Therapymentioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,356

1,412

View full text Add to dashboard Cite

show abstract

“…(32) It has been published alarming report from American authors; the detection of adenocarcinoma in three patients who underwent RFA for HGD in the field of BE, carcinoma was diagnosed a few months after the end of RFA treatment. (14) It can be assumed that carcinoma could have been in, when RFA was performed, but could not be caught up by simple biopsy based histopathologic examination. Reason to believe why cancer was present at the time of RFA treatment is the presence of carcinoma in the surgical resection specimens from a significant percentage (sometimes around one third) of patients with an initial diagnosis of HGD, who had been in the past decade indicated for esophagectomy.…”

Section: Resultsmentioning

confidence: 99%

“…Recent publications have reported the development of EAC in patients who were treated by RFA for HGD in BE field. (14)(15) These reports should raise the speculation that these patients possibly had cancer from the start, but not detected by standard biopsy. On the basis of this report, the decision to carry out this prospective study was made.…”

Section: Introductionmentioning

confidence: 93%

Diagnostic Accuracy of Endoscopic Biopsy Versus Mucosal Resection in Detecting Histopathologic Changes of Barrett’s Esophagus and Its Related Superficial Lesions.

Elsadek

Radwan

2014

Zagazig University Medical Journal

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Background: In most patients with Barrett's esophagus (BE), endoscopic surveillance for early detection of dysplastic or neoplastic changes depends on the results of forceps biopsy. Endoscopic mucosal resection (EMR) is rapidly growing as an excellent diagnostic and therapeutic method for BE with dysplastic and early neoplastic changes. It is not entirely clear what is the agreement between the histopathologic diagnosis based on biopsy specimen versus that based on mucosal resection specimen. Objective: The aim of this study was to check the accuracy of biopsy for precise histopathologic diagnosis of dysplasia and neoplasia, compared to EMR in patients with BE and its related superficial esophageal lesions. Methods: During the period from December 2011 to December 2013, 24 patients with previously diagnosed BE (18 men, 6 women, mean age 49.75 ± 13.3 years, range 32-83 years) underwent routine regular surveillance endoscopic examination. Targeted biopsies were taken from the visible lesions in 12 patients with macroscopically suspicious lesions of the esophagus (group 1), and 4 quadrant biopsies were taken from BE segments in 12 patients without visible lesions (group 2). Then EMR was performed within 3 weeks, in all patients. Results: Initial histopathologic diagnosis of biopsies were: non dysplastic BE (NDBE) in 11 cases, low-grade dysplasia (LGD) in 7 cases, high-grade dysplasia (HGD) in 4 cases, intramucosal carcinoma (IMC) in one case, and invasive adenocarcinoma (IAC) in one case. EMR based diagnosis was identical with biopsy based diagnosis in only 14 cases (58.33%). The diagnosis differed in 10 cases (41.67%); 9 of them (37.5%) had "Upgrading" (i.e. diagnosis towards a higher degree of dysplasia) of biopsy based diagnosis in comparison to EMR based diagnosis, while, only one case (4.17%) had "Downgrading" (i.e. diagnosis towards a lower degree of dysplasia) of biopsy based diagnosis in comparison to EMR based diagnosis. Conclusions: Endoscopic biopsy is not a satisfactory method for accurate diagnosis of esophageal dysplastic or neoplastic changes in BE patients with or without suspicious superficial lesions. EMR should therefore be the preferred diagnostic method in such patients.

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“…Durability of the method has been shown to be over 85% at 3 years and disease progression has been reported to be 1.37% per patient year in 127 patients with a 3-year follow-up (29). Limitations of this method include the lack of sample retrieval for histology analysis and the possibility of leaving undetected buried glands (32,33). In this manuscript we review the main endoscopic tools or procedures that enable organ preservation and discuss its performance.…”

Section: Radiofrequency Ablation (Rfa)mentioning

confidence: 99%

The impact of flexible endoscopy in esophageal surgery

et al. 2017

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Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy. This review presents a summary of the most relevant endoscopic techniques for both achalasia and esophageal cancer. Endoscopic advances in diagnostic and therapeutic arenas allow for minimally invasive therapies and organ preservation in most settings of achalasia and early stage neoplasia of the esophagus provided that the clinical setting and physician's expertise are prepared for this approach.

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Development of Subsquamous High-Grade Dysplasia and Adenocarcinoma After Successful Radiofrequency Ablation of Barrett's Esophagus

Cited by 117 publications

References 13 publications

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

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

Diagnostic Accuracy of Endoscopic Biopsy Versus Mucosal Resection in Detecting Histopathologic Changes of Barrett’s Esophagus and Its Related Superficial Lesions.

The impact of flexible endoscopy in esophageal surgery

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