Long-term recurrence of neoplasia and Barrett's epithelium after complete endoscopic resection

Anders, Mario; Bähr, Christina; El‐Masry, Muhammad Abbas; Marx, Andreas; Koch, Martin; Seewald, Stefan; Schachschal, Guido; Adler, Andreas; Soehendra, Nib; Izbicki, Jakob R.; Neuhaus, P.; Pohl, Heiko; Rösch, Thomas

doi:10.1136/gutjnl-2013-305538

Cited by 66 publications

(47 citation statements)

References 34 publications

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“…Following CEIM, the recurrence rate for IM is not inconsiderable, with some cohorts demonstrating rates of ≥20% at 2-3 years following CEIM ( 164,173,174 ). Th ough most recurrences are nondysplastic, up to a quarter may be dysplastic, including EAC ( 164,175 ).…”

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

1,356

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%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,356

1,412

View full text Add to dashboard Cite

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“…BTruly^hyperplastic polyps constitute separate subgroups in the WHO classification of serrated lesions in the colorectum [24]; in the past, they have been considered to harbour no malignant potential [25]. This, however, seems to be based on morphological assessment rather than on large and meticulous follow-up studies; furthermore, recent data suggest that mutational changes may already have occurred at the hyperplastic polyp stage [26].…”

Section: Discussionmentioning

confidence: 99%

Impact of reassessment of colonic hyperplastic polyps by expert GI pathologists

Schachschal

Sehner

Choschzick

et al. 2016

Int J Colorectal Dis

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BACKGROUND: Recommended follow-up intervals after endoscopic removal of hyperplastic polyps (HP) and sessile serrated adenomas (SSA) differ because of assumed differences in biological behaviour. However, histopathologic differentiation is difficult, with higher SSA rates reported from specialist GI histopathologists. OBJECTIVE: The objective of this study was to clarify the relevance of histologic reassessment of HP. DESIGN AND SETTING: From a prospective screening colonoscopy study relevant serrated lesions (excluding distal small HP 5 mm) diagnosed by private practice pathologists were reassessed by four specialized GI pathologists PATIENTS: One thousand sixty-nine screening colonoscopies were performed in patients. MAIN OUTCOME MEASUREMENTS: In terms of main outcome measurements, there is a likelihood of changes of the HP diagnosis on reassessment, as well as interrater variability. RESULTS: SSA were initially diagnosed in 7 cases (0.7 %) and relevant HP in 83 (7.8 %; 101 lesions). Of the latter, the chance of a change in diagnosis from HP to SSA by any of the four specialist histopathologists was higher for larger (>5 mm) and right-sided lesions (19.1 vs 1.3 %, OR 18.4, p = 0.04) including a higher likelihood to change recommended follow-up intervals (32.1 vs 3.3 %, p < 0.01). However, follow-up intervals were determined by concomitant adenomas in 41 %. Interrater variability was also higher for these lesions (p = 0.04), with an overall kappa value of 0.48. However, this issue related to only 1.2 % of the 1069 study cases. LIMITATION: The limitations this study are the limited case number as well as limited retrospective assessment. CONCLUSIONS: Right-sided HP >5 mm had a higher chance of change in diagnosis to SSA; therefore, they should probably be treated like adenomas and be removed. However, reliable data for recommendations on follow-up intervals of HP or SSA will require follow-up studies. Abstract Background Recommended follow-up intervals after endoscopic removal of hyperplastic polyps (HP) and sessile serrated adenomas (SSA) differ because of assumed differences in biological behaviour. However, histopathologic differentiation is difficult, with higher SSA rates reported from specialist GI histopathologists.Objective The objective of this study was to clarify the relevance of histologic reassessment of HP.Design and setting From a prospective screening colonoscopy study relevant serrated lesions (excluding distal small HP ≤5 mm) diagnosed by private practice pathologists were reassessed by four specialized GI pathologists Patients One thousand sixty-nine screening colonoscopies were performed in patients.Main outcome measurements In terms of main outcome measurements, there is a likelihood of changes of the HP diagnosis on reassessment, as well as interrater variability.Results SSA were initially diagnosed in 7 cases (0.7 %) and relevant HP in 83 (7.8 %; 101 lesions). Of the latter, the chance of a change in diagnosis from HP to SSA by any of the four specialist histopathologists was hig...

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“…Recurrence rates after complete eradication of IM have been reported to be higher than 20% after 2-3 years of follow-up (66,67). This is why a close follow-up for these patients should be performed with four-quadrant biopsies at 1 cm intervals throughout the previous BE segment and targeted biopsies of suspicious mucosal findings (21).…”

Section: Management and Treatment Of Bementioning

confidence: 99%