Endoscopic Resection for Barrett's High-Grade Dysplasia and Early Esophageal Adenocarcinoma: An Essential Staging Procedure With Long-Term Therapeutic Benefit

Moss, Alan; Bourke, Michael J.; Hourigan, Luke F.; Gupta, Saurabh; Williams, Stephen J.; Tran, Kayla; Swan, Michael P.; Hopper, Andrew D; Kwan, Vu; Bailey, Adam

doi:10.1038/ajg.2010.1

Cited by 186 publications

(138 citation statements)

References 40 publications

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“…Adequate training and expertise in the recognition of mucosal lesions that may harbor neoplasia is critical in order to target such endoscopic abnormalities with EMR. It is well known that EMR of mucosal abnormalities alters the pathologic stage in ∼ 50% of patients with clear management implications ( 113,192 ). Furthermore, all randomized clinical trials of radiofrequency ablation required endoscopic resection of mucosal abnormalities before application of radiofrequency ablation.…”

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

1,355

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 Evidencementioning

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

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“…On the other hand, Pech et al ( 16 ) reported that the rate of metachronous recurrence was 21.5 % and Moss et al ( 40 ) reported a rate of 11 % in Western countries. Th is recurrence rate is higher than that in our study.…”

Section: Esophagusmentioning

confidence: 99%

Comparison of the Long-Term Outcomes of Endoscopic Resection for Superficial Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus in Japan

Nakagawa

Koike

Iijima

et al. 2014

American Journal of Gastroenterology

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OBJECTIVES:Few studies have simultaneously evaluated the long-term outcomes of endoscopic resection (ER) for squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the esophagus in Japan. The objective of this study was to evaluate the long-term outcomes of ER for superfi cial esophageal cancer in consecutive patients. METHODS:This was a retrospective study from a single institution. From April 2001 to June 2012, 204 patients with SCC and 26 patients with AC were included from a total of 355 consecutive patients who were treated by esophageal ER at the Tohoku University Hospital. Patients with submucosal invasion deeper than 200 μ m and lymphovascular involvement were excluded. The intervention followed was endoscopic therapy. RESULTS:Overall survival, disease-free survival, and recurrence rates were evaluated as long-term outcomes. In the SCC group, during the median observation time of 36.5 months (range, 6 -120 months), 22 (10.8 % ) patients experienced metachronous recurrence, 4 (2.0 % ) patients experienced local recurrence, and 27 (13.2 % ) patients died from causes unrelated to SCC. In the AC group, during the median observation time of 45.5 months (range, 6 -131 months), one patient (3.8 % ) experienced metachronous recurrence and two (7.7 % ) died from causes unrelated to AC. The cumulative 5-year overall survival rates were not signifi cantly different between SCC (75.9 % ) and AC (88.9 % ) ( P = 0.120). The cumulative 5-year disease-free survival rates of SCC (57.1 % ) were signifi cantly lower than those of AC (85.2 % ; P = 0.017). The cumulative 5-year recurrence rates of SCC (32.0 % ) were signifi cantly higher than those of AC (4.2 % ; P = 0.023). CONCLUSIONS:The rate of recurrence after ER was higher in patients with SCC than that in patients with AC. These fi ndings suggest that, by detecting AC of the esophagus earlier, a satisfactory prognosis without recurrence can be expected after ER in Japan, and more rigorous endoscopic follow-up is necessary after ER in patients with SCC than in those with AC.

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“…1 and 2). furthermore, different studies have shown that staging by EMR can modify the previous biopsy diagnosis in up to 48 % of cases (93,102,103), which can dramatically change the clinical management of these patients, some of whom would be no longer suitable for endoscopic treatment due to histological evidence of submucosal invasion. Tumor staging using EMR pathology assessment is accurate when compared with surgical pathology, as shown in a study in 25 patients with HGD, IMC in Barrett's esophagus, where there was perfect agreement in T staging after EMR and esophagectomy (104).…”

Section: Endoscopic Mucosal Resection (Emr)mentioning

confidence: 99%