Endoscopic resection for treatment of mucosal Barrett's cancer: time to swing the pendulum

Bergman, Jacques J.G.H.M.

doi:10.1016/j.gie.2006.10.024

Cited by 12 publications

(5 citation statements)

References 18 publications

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“…Endoscopic therapy of early Barrett's neoplasia can be divided into two distinct categories: endo− scopic resection techniques and endoscopic abla− tive techniques. Endoscopic resection of focal le− sions may result in their complete removal and allows for histological assessment [5,8,9]. This enables proper patient selection, with patients showing submucosal invasion being referred for subsequent surgery, and those with mucosal neoplasia being amendable for additional endo− scopic management.…”

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confidence: 99%

Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients

et al. 2008

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Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients

et al. 2008

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“…5) compared to endoscopic therapy is firstly, well, its price! Management of the hazards of esophagectomy require major intensive care resources 98–99 . Mortality from esophagectomy or just “scraping through” can be extremely expensive in terms of in‐hospital costs.…”

Section: Expert‐confirmed High‐grade Dysplasia—management By Surgery mentioning

confidence: 99%

“…Secondly, death is a socially devastating and frequently costly problem, ranging from about 4–20%, depending on surgical and intensive‐care expertise. Just over half of all esophagectomies are done in “low‐volume” centers (< 7 cases per year) which have mortalities that range from 16.2% to 20.3% 50,98 . The major morbidity associated with esophagectomy is the third major price, both immediate and long term.…”

Section: Expert‐confirmed High‐grade Dysplasia—management By Surgery mentioning

confidence: 99%

Barrett's esophagus: A historical perspective, an update on core practicalities and predictions on future evolutions of management

Dent

2011

J of Gastro and Hepatol

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Interpretation of exploding knowledge about Barrett's esophagus is impaired by use of several conflicting definitions. Because any histological type of esophageal columnar metaplasia carries risk for esophageal adenocarcinoma, the diagnosis of Barrett's esophagus should no longer require demonstration of intestinal-type metaplasia. Endoscopic recognition and grading of Barrett's esophagus remains a significant source of ambiguity.Reflux disease is a key factor for development of Barrett's esophagus, but other factors must underlie its development, since it occurs in only a minority of reflux disease patients. Neither antireflux surgery nor proton pump inhibitor (PPI) therapy has major impacts on cancer risk. Within a year, a major trial should indicate whether low-dose aspirin usefully reduces cancer risk.The best referral centers have transformed the accuracy of screening and surveillance for early curable esophageal adenocarcinoma by use of enhanced and novel endoscopic imaging, visually-guided, rather than blind biopsies and by partnership with expert pathologists. General endoscopists now need to upgrade their skills and equipment so that they can rely mainly on visual targeting of biopsies on mucosal areas of concern in their surveillance practice. General pathologists need to greatly improve their interpretation of biopsies.Endoscopic therapy now achieves very high rates of cure of high-grade dysplasia and esophageal adenocarcinoma with minimal morbidity and risk. Such results will only be achieved by skilled interventional endoscopists. Esophagectomy should now be mainly restricted to patients whose cancer has extended into and beyond the submucosa.Weighing risks and benefits in the management of Barrett's esophagus is difficult, as is the process of adequately informing patients about their specific cancer risk. Key wordsBarrett's esophagus, diagnosis, endoscopic therapy, esophageal adenocarcinoma, surgery. CorrespondenceProfessor John Dent, Department of Gastroenterology & Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email: john.dent@health.sa.gov.au Conflict of interestNo potential conflict of interest to disclose. DedicationThis article is dedicated to the memory of Dr Derek (WD) Wylie (1918Wylie ( -1998, my uncle by marriage, who supported me gently but effectively in my choice of medicine as a career and welcomed me into his home. Derek Wylie, who was one of the pioneers of muscle-relaxant anesthesia, regularly anesthetized Norman Barrett's patients at St Thomas' Hospital, London. Though I did not know this before he died, Derek was a good friend of the Barrett family and played a significant long-term supportive role for one of its members. Derek Wylie had symptomatically mild reflux disease. Ironically, he presented with an advanced esophageal adenocarcinoma at the age of 78. Highly-skilled surgery and post-operative care gave him much-valued effective palliation before he died because of metastatic esophageal adenocarcinoma.

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“…Additional concerns include the risk of metachronous lesions, the need for long-term surveillance, the failure of these procedures to address the underlying causes of the BE, and the absence of long-term follow-up studies. 66 Complications from EMR include bleeding, perforation, and stenosis (although the risk is less than for ablation or PDT); some of these problems may be managed endoscopically at the time of the EMR procedure. 67 The risk for esophageal stricture can be diminished by limiting the extent of resection at each endoscopy and by performing staged resections of the Barrett's epithelium several weeks apart.…”

Section: High-grade Dysplasia In Barrett's Esophagusmentioning

confidence: 99%

Preemptive Surgery for Premalignant Foregut Lesions

Sharma

London

Magenta

et al. 2009

Journal of Gastrointestinal Surgery

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Endoscopic resection for treatment of mucosal Barrett's cancer: time to swing the pendulum

Cited by 12 publications

References 18 publications

Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients

Stepwise circumferential and focal ablation of Barrett’s esophagus with high-grade dysplasia: results of the first prospective series of 11 patients

Barrett's esophagus: A historical perspective, an update on core practicalities and predictions on future evolutions of management

Preemptive Surgery for Premalignant Foregut Lesions

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