Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitals

Nieuwenhuis, Esther; Munster, Sanne van; Curvers, Wouter L.; Weusten, Bas L.; Herrero, Lorenza Alvarez; Bogte, Auke; Alkhalaf, A.; Schenk, B.E.; Koch, Arjun D.; Spaander, Manon; Tang, Thjon J.; Nagengast, Wouter B.; Westerhof, Jessie; Houben, Martin H.; Bergman, Jacques; Schoon, Erik J.; Pouw, Roos E.

doi:10.1055/a-1754-7309

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…However recently, in a Dutch cohort of 168 patients with persistent BO-LGD, Nieuwenhuis et al reported visible lesions detected in 7% (n=12) of patients [7]. Whilst Tsoi et al, in a cohort of 75 patients with BO-LGD, identified 18.7% of patients had visible BO-LGD lesions [8].…”

Section: Introductionmentioning

confidence: 98%

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Endoscopic features of low-grade dysplastic Barrett’s

Iyer

Lai

et al. 2023

Endosc Int Open

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Introduction Barrett’s oesophagus (BO) with low grade dysplasia (LGD) is considered usually endoscopically invisible and the endoscopic features are not well described. This study aims to (1) evaluate the frequency of visible BO-LGD, (2) compare the rates of BO-LGD detection in the community versus a Barrett’s referral unit (BRU) and (3) evaluate the endoscopic features of BO-LGD. Methods This is a retrospective analysis of a prospectively observed cohort of 497 patients referred to a BRU with dysplastic BO between 2008 and 2022. BO-LGD was defined as confirmation of LGD by expert GI pathologist(s). Endoscopy reports, images and histology reports were reviewed to evaluate the frequency of endoscopically identifiable BO-LGD and their endoscopic features. Results 135 patients (27.2%) had confirmed BO-LGD, of which 15 (11.1%) had visible LGD identified in the community. After BRU assessment, visible LGD was detected in 68 patients (50.4%). Three phenotypes were observed: (A) Non-visible LGD, (B) Elevated (Paris 0-IIa) lesions and (C) Flat (Paris 0-IIb) lesions with abnormal mucosal and/or vascular patterns with clear demarcation from regular flat BO. Majority (64.7%) of visible LGD were flat lesions with abnormal mucosal and vascular patterns. Endoscopic detection of BO-LGD increased over time (38.7% (2009-2012) vs. 54.3% (2018-2022)). Conclusion In this cohort, 50.4% of true BO-LGD was endoscopically visible, with increased recognition endoscopically over time and a higher rate of visible LGD detected at a BRU when compared with the community. BRU assessment of BO-LGD remains crucial, however improving endoscopy surveillance quality in the community is equally important.

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Section: Introductionmentioning

confidence: 98%

“…Majority (64.7%) of visible LGD were flat lesions with abnormal mucosal and vascular patterns. Endoscopic detection of BO-LGD increased over time (38.7% (2009-2012) vs. 54.3% (2018-2022).…”

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confidence: 98%

Endoscopic features of low-grade dysplastic Barrett’s

Iyer

Lai

et al. 2023

Endosc Int Open

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“…Advanced endoscopic techniques have significantly improved the morbidity and mortality associated with premalignant conditions (as Barrett’s esophagus) and premalignant lesions (as most large colonic polyps) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ideally, the ablative tool should allow complete and sustained endoscopic and histological eradication of all Barrett’s mucosa, be easy to apply, and be safe. Currently, the preferred method for eradication is radiofrequency ablation (RFA) [ 1 , 3 ], in which heat induces necrosis of the target mucosa. However, this technique has some important drawbacks, including the need for expensive material and frequent endoscope reintroduction, usually with an over-the-scope apparatus of challenging use [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis

et al. 2023

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Hybrid argon plasma coagulation (hAPC) is a novel technique that combines conventional argon plasma coagulation and waterjet submucosal expansion. The aims of this metanalysis were to evaluate the efficacy and safety of hAPC in the setting of Barret’s esophagus (BE) ablation and as an adjunct to colonic endoscopic mucosal resection (EMR). Four electronic databases were searched, and the results were analyzed by two independent authors. Random-effects meta-analyses of the proportions of endoscopic and histologic remission (for BE), recurrence, and post-procedure adverse events were performed using R. Studies’ reporting quality was also assessed. From the 979 identified records, 13 studies were included (10 regarding BE and three colonic EMR). The pooled percentages of endoscopic and histologic remission after hAPC for BE were 95% (95% confidence interval [CI] 91–99, I2 = 34) and 90% (95%CI 84–95, I2 = 46), respectively, while major adverse events and recurrence were registered in 2% (95%CI 0–5, I2 = 41) and 11% (95%CI 2–27, I2 = 11), respectively. Concerning hAPC-assisted EMR, the pooled percentages of major adverse events and recurrence were 5% (95%CI 2–10, I2 = 0) and 1% (95%CI 0–3, I2 = 40). Evidence suggests that the main advantages of hAPC are the increase in safety in the setting of BE ablation and the reduction of local recurrence after colonic EMR. Trials comparing hAPC with standard strategies are required to support its use for these indications.

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“…In this issue of Endoscopy, Nieuwenhuis et al address this issue [3]. The authors compared the endoscopic examination performed in a BE expert center with that in a community hospital, in patients referred for flat low grade dysplasia (LGD) that had been confirmed by an expert pathologist.…”

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confidence: 99%

Centralized care for the management of Barrett’s esophagus: the path forward or just an academic dream?

Trindade

2022

Endoscopy

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The incidence of esophageal adenocarcinoma (EAC) has been rising dramatically. Unfortunately the large majority of cases are diagnosed at late stages presenting with signs of dysphagia. Clearly, there are missed opportunities to screen and diagnose high risk patients earlier via endoscopic assessment. However, even among those who have undergone surveillance endoscopy for Barrett's esophagus (BE), up to 24 % will still go on to develop EAC within 1 year [1]. This raises two questions: What are we doing wrong? How effective is endoscopic surveillance of Barrett's esophagus at preventing esophageal cancer? In order to be effective, the endoscopist needs to perform a high quality examination and recognize high risk lesions. A high quality examination usually consists of documenting the pertinent landmarks [2] (e. g. location of the z-line and pinch, and the Prague criteria), spending 1 minute per centimeter of BE closely examining the mucosa using high definition endoscopy and electronic chromoendoscopy (e. g. narrow-band imaging), targeting visible lesions, and adhering to systemic biopsy protocols. Is this comprehensive examination better performed among centers of excellence for BE? "...our patients could be greatly served by consistent and clear recommendations worldwide: that complex Barrett's esophagus (e. g. long-segment disease or BE with a strong family history of BE or esophageal adenocarcinoma), or BE with confirmed dysplasia, should be evaluated and treated at a BE center of excellence (defined by volume of BE cases performed)."Centralized care for the management of Barrett's esophagus: the path forward or just an academic dream?Referring to Nieuwenhuis EA et al.

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Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitals

Cited by 11 publications

References 31 publications

Endoscopic features of low-grade dysplastic Barrett’s

Endoscopic features of low-grade dysplastic Barrett’s

Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis

Centralized care for the management of Barrett’s esophagus: the path forward or just an academic dream?

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