Impact of advanced endoscopic imaging on Barrett’s esophagus in daily clinical practice

Beg, Sabina; Mensa, Mussa; Fullard, Mark; Finerty, E; Richman, P. I.; Leahy, Anthony

doi:10.1016/j.gie.2017.09.012

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…Cost-effectiveness analysis was not applicable in the base-case analysis as it was assumed that NBI and HD-WLE had the same diagnostic performance based on per-patient sensitivity and specificity. This conservative approach was adopted in order not to overstate the benefit of NBI, considering that: i) the primary evidence used in the model from Sharma et al [17] concluded that NBI is as effective as HD-WLE but safer; ii) other evidence showed superior comparable diagnostic accuracy of NBI vs HD-WLE [38,39]. Therefore, the two techniques resulted in an identical number of correctly identified dysplasia cases (N = 1.935 mln) and the same number of successful eradications (N = 77,331).…”

Section: Resultsmentioning

confidence: 99%

Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model

Furneri¹,

Klausnitzer

Haycock³

et al. 2019

PLoS ONE

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Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; capital equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on capital equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.

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Section: Resultsmentioning

confidence: 99%

Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model

Furneri¹,

Klausnitzer

Haycock³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…This has led to a reliable detection of high grade dysplasia (HGD) and early esophageal adenocarcinomas (EAC) in Barrett's esophagus [2,3]. However, low grade dysplasia (LGD) is generally considered to be undetectable endoscopically, despite our best imaging modalities [3,4]. The progression rate of LGD varies significantly in the literature from 0.4 % to 13.4 % [5,6].…”

Section: Introductionmentioning

confidence: 99%

Diffuse endoscopically visible, predominantly low grade dysplasia in Barrett’s esophagus (with video)

et al. 2019

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Background Low grade dysplasia (LGD) in Barrett’s esophagus (BE) has generally been considered as undetectable endoscopically. Aim To describe a phenotype which consists of diffuse, endoscopically visible, predominantly low grade dysplasia in Barrett’s esophagus (DEVLB), with often subtle but visible endoscopic changes seen with high definition white light (HDWL) and narrow-band imaging (NBI). Method A systematic search of a prospectively collected database for patients satisfying predefined criteria for DEVLB and a review of endoscopic and histological features of biopsies and endoscopic mucosal resection (EMR) specimens. Results Out of a total of 419 patients referred to our expert center for assessment of dysplastic Barrett’s esophagus during the period January 2009 to March 2018, there were 7 patients (1.7 %) who satisfied the criteria defined for DEVLB, identified on their initial assessment endoscopy. All patients were treated by EMR of visible abnormal mucosa during their assessment endoscopy at our tertiary referral center. There was a total of 47 EMR specimens obtained, with a median of 6 (IQR 5–9) EMR resection pieces per patient, of which 36 (77 %) contained LGD, 8 (17 %) high grade dysplasia (HGD), 2 (4 %) non-dysplastic Barrett’s esophagus (NDBE), and 1 (2 %) contained early esophageal adenocarcinoma (EAC). Conclusion DEVLB is a distinct phenotype seen in a small but significant proportion of individuals with dysplastic Barrett’s esophagus. Patients with DEVLB have widespread LGD, with many having areas of focal HGD or early cancer within this area. We believe these patients are best treated with extensive EMR of the visibly abnormal area.

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“… 64 , 65 , 66 Although some studies demonstrated different imaging modalities to be efficient, in other studies the use of these techniques did not report benefits in dysplasia detection rate. 67 , 68 , 69 , 70 Sensitivity of standard protocol with 4‐quadrant biopsy ranged from 28% to 85% in different studies and specificity varied from 56% to 100%, this led American Society for Gastrointestinal Endoscopy to set thresholds for any Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) 71 : an imaging technology with targeted biopsies should have a per‐patient sensitivity of 90% or greater, negative predictive value (NPV) of 98% or greater for detecting HGD or early EAC and specificity of at least 80% to allow a reduction in the number of biopsies compared to standard protocol.…”

Section: Endoscopic Evaluation In Be and Eac: Standard Procedures And Computer‐aided Detection (Cad)mentioning

confidence: 99%

Barrett's esophagus: The pathomorphological and molecular genetic keystones of neoplastic progression

et al. 2021

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Barrett's esophagus is a widespread chronically progressing disease of heterogeneous nature. A life threatening complication of this condition is neoplastic transformation, which is often overlooked due to lack of standardized approaches in diagnosis, preventative measures and treatment. In this essay, we aim to stratify existing data to show specific associations between neoplastic transformation and the underlying processes which predate cancerous transition. We discuss pathomorphological, genetic, epigenetic, molecular and immunohistochemical methods related to neoplasia detection on the basis of Barrett's esophagus. Our review sheds light on pathways of such neoplastic progression in the distal esophagus, providing valuable insight into progression assessment, preventative targets and treatment modalities. Our results suggest that molecular, genetic and epigenetic alterations in the esophagus arise earlier than cancerous transformation, meaning the discussed targets can help form preventative strategies in at-risk patient groups.

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Impact of advanced endoscopic imaging on Barrett’s esophagus in daily clinical practice

Cited by 9 publications

References 20 publications

Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model

Economic value of narrow-band imaging versus white light endoscopy for the diagnosis and surveillance of Barrett’s esophagus: Cost-consequence model

Diffuse endoscopically visible, predominantly low grade dysplasia in Barrett’s esophagus (with video)

Barrett's esophagus: The pathomorphological and molecular genetic keystones of neoplastic progression

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