Latest Developments in the Endoscopic Management of Gastroesophageal Reflux Disease and Barrett’s Esophagus: an Overview of the Year’s Literature

Abstract

The development of endoscopic techniques for the treatment of gastroesophageal reflux disease has come to an abrupt halt after some of the most widely disseminated and best evaluated techniques were withdrawn from the market. This underlines the importance of conducting high-quality endoscopic research before techniques are adopted in routine practice. The endoscopic surveillance of patients with Barrett's esophagus needs to be improved in order to be cost-effective. Alternative techniques for tissue sampling are being explored (e. g., brush cytology, imaging cytometry), as well as the use of molecular markers, to select patients who are at risk and to improve compliance by patients. New endoscopic imaging techniques (such as autofluorescence endoscopy) may improve the detection of early neoplasia in those Barrett's patients who are at risk for malignant degeneration. Subsequent endoscopic treatment should primarily consist of an endoscopic resection technique with restricted use of ablative therapies. Future studies should focus on the development of endoscopic resection techniques that allow en-bloc resection of Barrett's lesions, stepwise complete resection of the whole Barrett's segment, and/or easier and safer tissue ablation. Finally, histopathological studies are needed in order to detect risk factors for an adverse outcome after endoscopic treatment for early neoplasia in Barrett's patients.

Stepwise Radical Endoscopic Resection of the Complete Barrett??s Esophagus With Early Neoplasia Successfully Eradicates Preexisting Genetic Abnormalities

“…15 Balancing these factors will lead to endoscopic resection in the majority of patients with early Barrett neoplasia, provided that the management consists of an endoscopic resection after appropriate endoscopic staging and expert histopathologic evaluation of the resected specimens.…”

Endoluminal fundoplication (ELF) – evolution of EsophyX™, a new surgical device for transoral surgery

“…Third, transmural plication and suturing devices to create pleats in the gastroesophageal junction (GEJ) to enhance the competency of the gastric cardia pleating (12)(13)(14)(15)(16)(17). The radiofrequency and injection procedures, however, have suffered from a variety of problems, including serious adverse events (SAEs) such as esophageal perforation (18) as well as short and medium-term efficacy falling short of initial expectations (1,19,20). As a result, these devices were removed from the market by the manufacturers or required additional sham-controlled trials to verify their effectiveness compared to placebo (1,20).…”

“…The trans-oral, endoluminal full-thickness plicators continue to provide the most promising alternatives to laparoscopic anti-reflux surgery (LARS) and medical anti-secretory therapies with proton pump inhibitors (PPIs) (1,19,20). Suturing procedures offer easy repeatability, short operative time, early discharge, little morbidity, and symptomatic improvement (1).…”

Ανοσοϊστοχημική, Ανοσολογική Και Γενετική Μελέτη Σε Εξειδικευμένη Εντερική Μεταπλασία Γαστροοισοφαγικής Συμβολής

“…Η χρήση χρωµοενδοσκόπησης µε εκλεκτική πρόσληψη των χρησιµοποιούµενων χρωστικών (κυανού του µεθυλενίου) από το εξειδικευµένο µεταπλαστικό επιθήλιο του ΟΒ και τη λήψη βιοψιών ή κυτταρολογικών επιχρισµάτων συµβάλλουν στην αναγνώριση της παρουσίας ΟΒ ή δυσπλαστικών αλλοιώσεων (Marin 2006, Yagi 2005, Amano 2005, Wo 2004, Blustein 1998, Canto 1996. Έχουν εισαχθεί νεότερες ενδοσκοπικές οπτικές τεχνικές που περιλαµβάνουν σπινθηρογραφική φασµατοσκοπία, οπτική φασµατοσκοπία και οπτική τοµογραφία (Bergman 2006). Οι µέθοδοι αυτές στηρίζονται στη διαφορετική απεικόνιση ιστών µε νεοπλασµατικά ή µη νεοπλασµατικά χαρακτηριστικά.…”