High-resolution endoluminal sonography is a sensitive modality for the identification of Barrett's metaplasia

Adrain, Alyn L.; Ter, H.; Cassidy, Michael J.; Schiano, Thomas D.; Liu, Ji‐Bin; Miller, Larry S.

doi:10.1016/s0016-5107(97)70063-4

Cited by 55 publications

(30 citation statements)

References 6 publications

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“…HFPUS was not highly accurate for detecting invasive esophageal cancer in patients with BE and HGD or ICA (23). As in the study by Adrain et al [22], the authors found that HFPUS showed thickening of the mucosal sonographic layers of the esophagus in all nine of our patients. Although there was some correlation between the HFPUS and surgical pathology findings in six patients (67 %), HFPUS mistakenly diagnosed cancer in one patient (11 %) and missed cancers in two (22 %).…”

Section: Eus and Emr/esdsupporting

confidence: 52%

“…In contrast to the five-layered gastrointestinal wall structure seen with conventional EUS, HFPUS reveals 7±9 layers. There is better definition of the mucosa with clearer visualization of the muscularis mucosae, features that conceivably might result in better staging of neoplasia in BE [21,22]. Adrain et al used HFPUS to evaluate 17 patients with BE (3 with dysplasia) and 12 control subjects [22].…”

Section: Eus and Emr/esdmentioning

confidence: 99%

“…There is better definition of the mucosa with clearer visualization of the muscularis mucosae, features that conceivably might result in better staging of neoplasia in BE [21,22]. Adrain et al used HFPUS to evaluate 17 patients with BE (3 with dysplasia) and 12 control subjects [22]. BE was diagnosed when the second hypoechoic layer was thicker than the first hyperechoic layer of the mucosa and, using these criteria, HFPUS was 100 % accurate in distinguishing patients with BE from normal.…”

Section: Eus and Emr/esdmentioning

confidence: 99%

See 2 more Smart Citations

EUS and EMR/ESD: Is EUS in patients with Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma necessary prior to endoscopic mucosal resection?

Waxman¹

2006

Endoscopy

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The management of patients with HGD in BE remains controversial, largely because the natural history of this condition is so poorly defined. For example, Reid et al. reported a 59 % 5-yr cumulative cancer incidence among 76 patients with HGD in BE [1],whereas Schnell et al. found that only 12 (16 %) of their 75 patients with HGD developed adenocarcinoma during a mean follow-up period of 7.3 yr [2]. Four management options have been proposed for patients with HGD in BE: (1) esophagectomy, (2) endoscopic ablative therapies, (3) EMR, and (4) intensive endoscopic surveillance, in which invasive therapy is withheld until biopsy specimens show evidence of invasion [3]. Clearly, there are risks associated with all of these approaches, and all would benefit from accurate staging of the neoplasia. Estimation of the depth of tumor penetrationThe less than perfect reliability of endoscopic staging with the adjunct of chromo endoscopy and magnification endoscopy for the estimation of cancer depth before EMR can be improved by the use of endoscopic ultrasonography (EUS), in particular highfrequency US probe sonography (HFUPS). HFUPS may distinguish nine layers within the wall of GI organs in contrast to a five-layered structure seen with conventional EUS, thus providing better images that are useful in the evaluation of transmural penetration and in differentiating cancers limited to the mucosa from those with submucosal penetration. The main limitation of HFUPS is its tendency to overstage early lesions. The diagnostic accuracy of HFUPS in assessing depth of tumor invasion in the esophagus, stomach and colon ranges from 67 % to 94 % among the published studies [4 ± 9]. This high variability in HFUPS accuracy may reflect the use of probes with different penetration (15MHz versus 20MHz) and differences in the patient populations studied. Accuracy of HFUPS, in fact, is significantly better for elevated type lesions than for depressed ones [7].When different techniques are used in combination to select lesions suitable for EMR, the overall accuracy is high [10]. Because of the limitations of these staging techniques, however, it has been suggested that when a lesion meets the generally accepted criteria of size, and appearance is encountered, EMR can be performed without prior HFUPS, as long as the lesion can safely be removed in its entirety [11 ± 12]. Submucosal injection used to facilitate EMR can also help to decide whether or not to continue with the procedure [13]. The observation of a bleb formation with elevation of the overlying mucosa indicates the absence of deep submucosal involvement and the feasibility of EMR [30] On the other hand, the dense fibrosis associated with deep submucosal invasion prevents fluid infiltration through the submucosal connective tissue, decreasing bleb formation and elevation of the lesion [14]. This so-called ªnon-lifting sign has been found to have 100 % sensitivity, 99 % specificity, and 83 % positive predictive value for invasive carcinoma in patients with early cancer of the colon [15...

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Section: Eus and Emr/esdsupporting

confidence: 52%

Section: Eus and Emr/esdmentioning

confidence: 99%

Section: Eus and Emr/esdmentioning

confidence: 99%

See 1 more Smart Citation

EUS and EMR/ESD: Is EUS in patients with Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma necessary prior to endoscopic mucosal resection?

Waxman¹

2006

Endoscopy

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“…Three-dimensional reconstruction of the ultrasound images was performed. It was found that the plications appeared as hypoechoic round structures on 2-dimensional ultrasound and hypoechoic spherical structures on 3-dimensional ultrasound ( fi g. 25 ). The sutures within the plications appeared as hyperechoic lines.…”

Section: Gastroesophageal Refl Ux Disease (Gerd)mentioning

confidence: 98%

Use of Endoluminal Ultrasound to Evaluate Gastrointestinal Motility

Miller¹,

Dai²,

Korimilli³

et al. 2006

Dig Dis

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The use of high-frequency ultrasound transducers in the gastrointestinal tract (GI) has already yielded remarkable findings concerning the anatomy, physiology and pathophysiology of the GI tract and of various motility disorders. These transducers have made completely invisible portions of the GI tract (the longitudinal smooth muscle, muscles of the upper esophageal sphincter, components of the gastroesophageal junction high-pressure zone, and the muscle of the anal sphincter complex) accessible to investigation. Use of simultaneous ultrasound and manometry has allowed the exploration of the normal physiology of peristaltic contraction. The components of the high-pressure zone of the distal and proximal esophagus have been isolated and the movement of these components has been studied individually and as a group. Various esophageal motility disorders have been investigated including achalasia, scleroderma, Barrett’s esophagus and diffuse esophageal spasm. The possible etiology of the symptoms of esophageal chest pain and heartburn (sustained esophageal contractions of the longitudinal smooth muscle), have been studied. The possible underlying pathophysiology of GERD (the missing gastric clasp and sling fiber pressure profile) has been explored. Three-dimensional high-frequency ultrasound imaging has allowed the peristaltic contraction sequence to be viewed in a completely new and unique manner. The biomechanics of both esophageal contraction and the gastroesophageal junction high-pressure zone have been investigated and the mechanical advantage of esophageal shorting has been studied. The mechanism of action of standard surgical and newer endoscopic therapies for GERD has been defined. Future applications of this technology are limited only by our imagination.

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“…Adrain et al [53] evaluated the ability of high-resolution endoluminal sonography (20 MHz) to detect the mucosal changes in Barrett's esophagus, assuming a second hypoechoic layer thicker than the first hyperechoic one as being representative of Barrett's. All of 17 patients with Barrett's were correctly identified by this technique (sensitivity 100%), however dysplasia could not be correctly identified.…”

Section: Eus Rate Bmentioning

confidence: 99%

Endoscopic Ultrasonography

Caletti¹,

Fusaroli²,

Buracco³

1998

Digestion

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Endoscopic ultrasonography (EUS) is nowadays a clinically relevant technology and its findings can have a major impact on patient management. This technique is currently indicated for staging digestive cancers, assessment of submucosal tumors, diagnosis of intestinal wall infiltrative diseases, common bile-duct stones and gut neuroendocrine tumors. As far as neoplasms are concerned, EUS appears to be a reliable and safe technique, thus making the physician able to plan either an aggressive surgical treatment, or a conservative palliative therapy. This is of the utmost importance in order to optimize medical-related costs, and to make the best therapeutic decision for each individual patient. EUS is also helpful in monitoring the course of a disease, as it is simple and virtually without complications. When EUS findings are not sufficient for a complete diagnosis, it is now possible to perform an EUS-guided fine-needle biopsy, which can allow a cytological diagnosis. Finally, some therapeutic endosonography-guided procedures are being increasingly adopted, such as cystoenterostomy, celiac plexus neurolysis, cholangio-pancreatography and selective injection of botulinum toxin in the muscle layer of the lower esophageal sphincter.

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High-resolution endoluminal sonography is a sensitive modality for the identification of Barrett's metaplasia

Cited by 55 publications

References 6 publications

EUS and EMR/ESD: Is EUS in patients with Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma necessary prior to endoscopic mucosal resection?

EUS and EMR/ESD: Is EUS in patients with Barrett’s esophagus with high-grade dysplasia or intramucosal adenocarcinoma necessary prior to endoscopic mucosal resection?

Use of Endoluminal Ultrasound to Evaluate Gastrointestinal Motility

Endoscopic Ultrasonography

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