Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus

Pech, Oliver; Behrens, Angelika; May, Andrea; Nachbar, Lars; Goßner, Liebwin; Rabenstein, Thomas; Manner, Hendrik; Guenter, Erwin; Huijsmans, Josephus; Vieth, Michael; Stolte, Manfred; Ell, Christian

doi:10.1136/gut.2007.142539

Cited by 638 publications

(479 citation statements)

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“…In this role, the adjunct use of a narrow light spectrum imaging technology, such as narrow band imaging, may aid in detecting mucosal irregularity ( 144 ). 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 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

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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%

“…Cohort studies document that up to one-third of patients treated with EMR who achieve complete resection of the primary lesion will subsequently develop recurrent HGD or EAC ( 145 ). Whether these subsequent lesions represent undetected metachronous lesions or a fi eld eff ect in the susceptible patient is unclear.…”

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

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“…On the other hand, Pech et al ( 16 ) reported that the rate of metachronous recurrence was 21.5 % and Moss et al ( 40 ) reported a rate of 11 % in Western countries. Th is recurrence rate is higher than that in our study.…”

Section: Esophagusmentioning

confidence: 99%

“…In Western countries, some studies reporting results aft er ER for AC of the esophagus suggested a favorable prognosis, although the rates of local and metachronous recurrence were relatively high (4.2 ~ 21.5 % ) ( 15,16 ). Similarly, in Japan, some studies suggested a favorable prognosis aft er ER for SCC of the esophagus (0 ~ 2.3 % ) ( 17,18 ), although the rates of local and metachronous recurrence were also relatively high (16.4 ~ 20 % ) ( 19,20 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Long-Term Outcomes of Endoscopic Resection for Superficial Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus in Japan

Nakagawa

Koike

Iijima

et al. 2014

American Journal of Gastroenterology

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OBJECTIVES:Few studies have simultaneously evaluated the long-term outcomes of endoscopic resection (ER) for squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the esophagus in Japan. The objective of this study was to evaluate the long-term outcomes of ER for superfi cial esophageal cancer in consecutive patients. METHODS:This was a retrospective study from a single institution. From April 2001 to June 2012, 204 patients with SCC and 26 patients with AC were included from a total of 355 consecutive patients who were treated by esophageal ER at the Tohoku University Hospital. Patients with submucosal invasion deeper than 200 μ m and lymphovascular involvement were excluded. The intervention followed was endoscopic therapy. RESULTS:Overall survival, disease-free survival, and recurrence rates were evaluated as long-term outcomes. In the SCC group, during the median observation time of 36.5 months (range, 6 -120 months), 22 (10.8 % ) patients experienced metachronous recurrence, 4 (2.0 % ) patients experienced local recurrence, and 27 (13.2 % ) patients died from causes unrelated to SCC. In the AC group, during the median observation time of 45.5 months (range, 6 -131 months), one patient (3.8 % ) experienced metachronous recurrence and two (7.7 % ) died from causes unrelated to AC. The cumulative 5-year overall survival rates were not signifi cantly different between SCC (75.9 % ) and AC (88.9 % ) ( P = 0.120). The cumulative 5-year disease-free survival rates of SCC (57.1 % ) were signifi cantly lower than those of AC (85.2 % ; P = 0.017). The cumulative 5-year recurrence rates of SCC (32.0 % ) were signifi cantly higher than those of AC (4.2 % ; P = 0.023). CONCLUSIONS:The rate of recurrence after ER was higher in patients with SCC than that in patients with AC. These fi ndings suggest that, by detecting AC of the esophagus earlier, a satisfactory prognosis without recurrence can be expected after ER in Japan, and more rigorous endoscopic follow-up is necessary after ER in patients with SCC than in those with AC.

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“…In cases with superficial submucosal invasion and high risk of complications with esophagectomy, endoscopic resection and ablation therapies can be considered a good therapeutic option, with encouraging results in highly selected patients (64). Ablation therapies after mucosal resection are highly recommended to eliminate the remainder BE, decreasing the risk of recurrence (65). In contrast, patients with deeper submucosal invasion have higher rates of lymphovascular involvement (63) and a multidisciplinary surgical oncology evaluation should be performed to assess the utility of endoscopic therapies, which are usually aimed to palliation (21).…”

Section: Management and Treatment Of Bementioning

confidence: 99%