Guideline to Practice: Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline

Shaheen, Nicholas J.; Falk, Gary W.; Iyer, Prasad G.; Souza, Rhonda F.; Wani, Sachin

doi:10.14309/ajg.0000000000001788

Cited by 34 publications

(49 citation statements)

References 19 publications

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“…An important driver for the use of ESD for early BE neoplasia is the expanding indication of endoscopic treatment for submucosal cancers. Current guidelines advise esophagectomy for lesions with deep submucosal (sm2–sm3) invasion 8 9 10 given the risk of local lymph node metastasis, but this is based on surgical studies that are limited in quality and quantity 11 12 . Recent series of endoscopic treatment of submucosal cancers indicate that this risk may be much lower than generally assumed 4 13 14 .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, ESD has inherent disadvantages compared to multiband mucosectomy, most importantly greater technical difficulty, a longer learning curve, and longer procedure times. Multiband mucosectomy is therefore still the preferred approach for most early BE neoplasia, whereas ESD will be preferred in lesions with suspected (deep) submucosal invasion and in lesions where a cap-based approach is technically not feasible 8 9 10 .…”

Section: Introductionmentioning

confidence: 99%

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Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

et al. 2021

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Objective The use of endoscopic submucosal dissection (ESD) is gradually expanding for treatment of neoplasia in Barrett’s esophagus (BE). We aimed to report outcomes of all ESDs for BE neoplasia performed inNL. Design We retrospectively assessed ESD outcomes in NL, where treatment for BE neoplasia is centralized in 9 expert centers with jointly trained endoscopists and pathologists, and treatment/follow-up data collected in a joint database. ESD is restricted for selected cases. Results During median 121 minutes (p25-p75 90-180), 130 complete ESDs were performed with 97% (126/130) removed en-bloc. Pathology was HGD (5%), T1a-EAC (43%) or T1b-EAC (52%; 19%sm1, 33%≥sm2). The combined en-bloc and R0 rate was 87% [95%-CI 77-94%] for HGD/T1a-EAC and 49% [37-62%] for T1b-EAC. Upon R1 resection, 29% had residual cancer, in all cases detected at first follow-up endoscopy, while the remaining 71% had no residual cancer in esophagectomy specimen (n=6) or during median 9 months endoscopic FU (p25-p75 4-22) (n=18). Upon R0 resection, local recurrence rate during median 17 months (8-30) was 0% [0-5%]. Adverse events: 1% perforation [0-4%], 3% post-procedural bleeding [1-7%], 13% strictures [8-20%]. Conclusion In expert hands, ESD is safe and allows for removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter is, however, associated with a positive deep resection margin in half of the patients, yet only one third had actual persisting neoplasia at endoscopic FU. To better stratify R1-patients with an indication for additional surgery, repeat endoscopy after healing of the ESD wound may help in predicting residual cancer.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

et al. 2021

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“…Eradication therapy for both stages of dysplasia in BE is currently considered standard of care 4 . Additionally, guidelines advocate eradicating residual Barrett’s metaplasia after complete endoscopic resection (ER) of early EAC because of the risk of metachronous lesions 5 6 .…”

Section: Introductionmentioning

confidence: 99%

Nonthermal resection device for ablation of Barrett’s esophagus: a feasibility and safety study

et al. 2021

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Background and study aims Several techniques exist for the eradication of Barrett’s esophagus (BE); however, all have limitations regarding successful conversion to squamous epithelium and a complication profile. We aimed to assess the feasibility and safety of a new non-thermal device, the EndoRotor, for the eradication of BE as a first-line ablation technique. Patients and methods Patients with BE were prospectively included in 2 tertiary referral centers in The Netherlands. Inclusion criteria: BE-length 2-5cm, with low-grade dysplasia, high-grade dysplasia or residual BE after endoscopic resection (ER) of a lesion containing early neoplasia. Exclusion criteria: previous ER >50% circumference, or previous ablation therapy. Follow-up endoscopy was performed after 3 months. Outcomes were the percentage of endoscopically visible BE surface regression and complications. Results Thirty patients (25 male, age 66 years [IQR: 59–73], median BE C0M3) were included. Eighteen patients underwent ER prior to ablation. Median percentage BE ablated was 100% (IQR: 94-100). Median visual BE surface regression at three-months follow-up was 80% (IQR: 68–95). Multiple residual Barrett’s islands were commonly seen. Six patients(20%) had a treatment-related complication requiring intervention, including one perforation(3%), one postprocedural hemorrhage(3%), and four strictures(13%). Post-procedural pain was reported in 18 patients(60%). Conclusions For the endoscopic ablation of BE, the EndoRotor procedure was found to be technically demanding with a longer procedure time compared to established ablation techniques and a high complication rate. Based on these results, we do not recommend the EndoRotor as a first-line ablation technique for the eradication of BE.

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“…However, endoscopic submucosal dissection (ESD) facilitates en bloc resection and provides better assessment of the lateral margin of the lesion. ESD is technically more difficult than EMR but can be performed when bulky lesions are encountered or when submucosal invasion is suspected 1 2 .…”

Section: Endoscopy E-videosmentioning

confidence: 99%

Traction-assisted endoscopic submucosal dissection with submucosal tunneling for Barrett’s esophagus nodularity

2021

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Guideline to Practice: Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline

Cited by 34 publications

References 19 publications

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

Extending treatment criteria for Barrett’s neoplasia: results of a nationwide cohort of 138 endoscopic submucosal dissection procedures

Nonthermal resection device for ablation of Barrett’s esophagus: a feasibility and safety study

Traction-assisted endoscopic submucosal dissection with submucosal tunneling for Barrett’s esophagus nodularity

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