Incidence of Adenocarcinoma among Patients with Barrett's Esophagus

Hvid-Jensen, Frederik; Pedersen, Lars; Drewes, Asbjørn Mohr; Sørensen, Henrik Toft; Funch‐Jensen, Peter

doi:10.1056/nejmoa1103042

Cited by 1,220 publications

(907 citation statements)

References 41 publications

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“…Th e available evidence to support this hypothesis, however, consists of retrospective studies that may be subject to biases. Indeed, >90% of EACs are diagnosed in patients without a prior BE diagnosis, despite the increasing use of endoscopy ( 67,68 ). Given the number of patients involved, a widely embraced population screening eff ort could lead to substantial economic costs (from diagnostic tests and need for subsequent surveillance).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…If such irregularity is detected, the next step in the management of that patient should be EMR or endoscopic submucosal dissection, both for therapeutic benefi t and to allow staging of the lesion ( 145,146 ). Although than previously believed ( 68,136,148 ). Given the low rate of progression in these patients, the low but real rate of complications of endoscopic therapy ( 149 ), and the costs associated with its delivery ( 150 ), ablative therapy cannot be recommended in patients with nondysplastic BE.…”

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,355

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,355

1,412

View full text Add to dashboard Cite

show abstract

“…SCC results from the formation of non-keratinized stratified squamous epithelium and is more common in developing countries. The preferential sites of SCC are the middle and upper thirds of the esophagus 1,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

et al. 2014

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PURPOSE:To analyze the epidemiological features of patients with esophageal cancer according to the histopathological types: squamous cell carcinoma or adenocarcinoma. METHODS:A total of 100 patients with esophageal cancer, being 50 squamous cell carcinomas and 50 adenocarcinomas were analyzed for demographics, nutritional factors, lifestyle habits, benign pathological conditions associated, like Barrett's esophagus and megaesophagus, tumor stage and survival rates. The nutritional factors evaluated included body mass index, percent weight loss, hemoglobin and albumin serum levels. RESULTS:Esophageal cancer occurred more often in men over 50 years-old in both histological groups. No significant differences on age and gender were found between the histological groups. Squamous cell carcinoma was significantly more frequent in blacks than adenocarcinoma. Alcohol consumption and smoking were significantly associated with squamous cell carcinoma. Higher values of body mass index were seen in patients with adenocarcinoma. Barrett's esophagus was found in nine patients (18%) with adenocarcinoma, and megaesophagus in two patients (4%) with squamous cell carcinoma. The majority of patients were on stages III and IV in both histological groups. The mean survival rates were 7.7 ± 9.5 months for patients with squamous cell carcinoma and 8.0 ± 10.9 months for patients with adenocarcinoma. No significant differences on tumor stage and survival rates were detected between the histological groups.CONCLUSION: Epidemiological features are distinct for the histopathological types of esophageal cancer. Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus.

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“…Despite the low risk of progression to EAC per annum, estimated currently at 0.12%, the prognosis of EAC is poor, with an estimated 5‐year survival of approximately 10–15% 1, 2…”

Section: Introductionmentioning

confidence: 99%

Risk stratifying the screening of Barrett's esophagus: An Asian perspective

et al. 2017

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Background and AimBarrett's esophagus (BE) is a premalignant condition for esophageal adenocarcinoma. Although risk factors exist for screening patients in the West, we aimed to determine the factors in terms of demographics and symptoms for patients in an Asian setting.MethodsWe recruited 1378 patients over a 7‐year period as part of an ongoing gastric cancer screening program. An appropriately designed questionnaire was utilized to determine the necessary risk factors and symptoms with endoscopic analysis and subsequent histological confirmation as the gold standard. We utilized the existence of intestinal metaplasia of the distal esophagus as the primary diagnostic pathology.ResultsWe demonstrated that no symptoms were indicative of BE in an Asian setting. Age (odds ratio 1.081, 95% confidence interval 1.022–1.143) and male gender (odds ratio 4.808, 95% confidence interval 1.727–13.33) proved significant demographic factors for the presence of intestinal metaplasia (P 0.007, 0.003, respectively).ConclusionsWe advocate the utilization of increasing age and male gender as the primary risk factors for patients at risk of BE. We also recommend astute examination of the distal esophagus whilst patients undergo simultaneous gastric cancer screening.

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Incidence of Adenocarcinoma among Patients with Barrett's Esophagus

Cited by 1,220 publications

References 41 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma

Risk stratifying the screening of Barrett's esophagus: An Asian perspective

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