EMR for Barrett's esophagus–related superficial neoplasms offers better diagnostic reproducibility than mucosal biopsy

Mino‐Kenudson, Mari; Hull, Mindy J.; Brown, Ian; Muzikansky, Alona; Srivastava, Amitabh; Glickman, Jonathan N.; Park, Do‐Youn; Zuckerberg, Lawrence; Misdraji, Joseph; Odze, Robert D.; Lauwers, Gregory Y.

doi:10.1016/j.gie.2007.02.063

Cited by 116 publications

(54 citation statements)

References 38 publications

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“…EMR will change the diagnosis in ∼ 50% of patients when compared with endoscopic biopsies, given the larger tissue sample available for review by the pathologist ( 113 ). Interobserver agreement among pathologists is improved as well ( 114 ). Th e safety of systematic endoscopic biopsy protocols has been demonstrated ( 115 ).…”

Section: Summary Of the 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

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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: Summary Of the 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

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“…EMR can also be used for staging purposes. Esophageal specimens obtained by EMR had better interobserver agreement regarding neoplasia compared with biopsy specimens [Mino-Kenudson et al 2007]. The guidelines about lesions suitable for EMR, described above for HGD, also apply for superficial EAC [Ell et al 2000;Takeshita et al 1997].…”

Section: Management Of Barrett's Esophagus With Intramucosal Carcinomamentioning

confidence: 92%

Review: Diagnosis and management of Barrett’s esophagus for the endoscopist

Garud

Keilin

Cai

et al. 2010

Therap Adv Gastroenterol

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In Barrett's esophagus, the stratified squamous epithelium lining the esophagus is replaced by specialized intestinal-type columnar epithelium. The prevalence of Barrett's esophagus has ranged from 0.9% to 4.5%. The rate of progression from Barrett's esophagus to esophageal adenocarcinoma is 0.5% per patient-year. Proton-pump inhibitors are the mainstay of symptom control in Barrett's patients. Nondysplastic Barrett's and Barrett's with low-grade dysplasia (LGD) are typically managed by periodic surveillance. Radiofrequency ablation is being evaluated as a modality for managing nondysplastic Barrett's and Barrett's with LGD. The options for the management of Barrett's patients with high-grade dysplasia (HGD) include endoscopic therapy, surgery, and intensive surveillance until biopsy reveals adenocarcinoma. Endoscopic therapy involves endoscopic mucosal resection (EMR) and ablation. More aggressive techniques such as endoscopic submucosal dissection and larger segment endoscopic mucosal resection are under study. In this review, we discuss the diagnosis and management of Barrett's esophagus. The recommendations from the major gastroenterologic societies and the current and investigational endoscopic modalities for the management of Barrett's esophagus with and without dysplasia are reviewed.

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“…Conio et al (109) and Mino-Kenudson et al (110) reported a changed histological diagnosis in 26 and 37%, respectively, of patients with BE undergoing EMR. Studies suggest that EMR may successfully eliminate early ADC with a low complication rate but relapse rates of 25-30% during the first 3 years when used as single therapy in patients with HGD or intramucosal ADC (111).…”

Section: Endoscopic Mucosal Resection (Emr)mentioning

confidence: 99%