Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study

Bhat, Shivaram; McManus, Damian; Coleman, Helen; Johnston, Brian T.; Cardwell, Christopher; McMenamin, Úna C.; Bannon, Finian; Hicks, Blánaid; Kennedy, Grace; Gavin, Anna; Murray, Liam

doi:10.1136/gutjnl-2013-305506

Cited by 131 publications

(114 citation statements)

References 21 publications

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“…Recent work from a large Dutch population-based cohort study confi rmed that there is a survival advantage for EAC in patients who received adequate endoscopic surveillance compared with patients who were not participating in endoscopic surveillance ( 100 ). Similarly, a large Northern Ireland populationbased study found that in patients with EAC and a prior diagnosis of BE, survival was enhanced, tumor stage was lower, and tumor grade was lower compared with patients without a prior diagnosis ( 101 ). Importantly, these fi ndings were maintained, although attenuated, aft er attempting to correct for both lead time and length time bias.…”

Section: Summary Of the 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 the 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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“…Surveillance has been shown to be beneficial as surveillance leads to diagnosis of oesophageal adenocarcinoma at an earlier stage and, hence, leads to improved survival [21]. The outcomes were better when compared to patients diagnosed outside of a screening programme and dramatically better than those who had already become symptomatic [22].…”

Section: Identifying Dysplasiamentioning

confidence: 99%

Detection of dysplasia in Barrett’s oesophagus: Are there impending optical and spectroscopic solutions?

Upchurch¹,

Old²,

Gr³

et al. 2016

Gastroenterol Hepatol Endosc

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The incidence of Barrett's oesophagus and oesophageal adenocarcinoma is increasing in Western countries. The outcome for patients with oesophageal cancer is extremely poor with only 15.1% of patients surviving for 5 years. The dismal outcome is largely due to late diagnosis which eliminates many patients from effective treatment.Oesophageal adenocarcinoma is often preceded by the development of dysplasia in a segment of Barrett's oesophagus. With the current surveillance strategies, it is extremely difficult to not only visualise areas of dysplasia, but also to accurately identify their morphological and architectural changes during histopathological diagnosis. Consensus statements recommend mucosal resection for dysplastic change in the oesophagus, thereby, preventing the development of adenocarcinoma. This strategy requires improved diagnostic tools that can reliably distinguish patients with dysplasia.Years of research have looked at a variety of different modalities that may aid with the current dilemma of difficulties in diagnosing dysplasia. This review looks at the modalities under development and analyses their advantages and the part they may well play in the future. It also looks at the future avenues that could be explored to aid in the understanding of the disease and to improve the outcomes.

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“…A large Northern Ireland population-based study and a large Dutch population-based study showed that in patients with EAC and a prior diagnosis of BE, survival was improved, and tumor stage and grade was lower compared with patients without a prior diagnosis of BE ( 9,10 ). Similarly, a cohort study of patients with BE diagnosed in the National Veterans Aff airs hospitals showed that surveillance endoscopy was associated with an early stage diagnosis of EAC, longer survival, and decreased overall and cancer-related mortality ( 11 ).…”

mentioning

confidence: 99%

Editorial: Best Practices in Surveillance of Barrett's Esophagus

Wani

Gaddam

2017

American Journal of Gastroenterology

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Endoscopic surveillance in Barrett's esophagus (BE) has numerous limitations and thus provides several opportunities for improving the effectiveness of our current surveillance strategies. Several risk stratifi cation and prediction tools have been investigated to identify patients at highest risk for progression to esophageal adenocarcinoma (EAC). Persistence of non-dysplastic BE (NDBE) has been proposed as an indicator of lower risk of progression to EAC. This editorial highlights the variable results and methodologies in studies evaluating persistence of NDBE as a risk stratifi cation tool in the surveillance of BE patients and provides guidance for optimizing outcomes in BE patients enrolled in surveillance programs. Am J Gastroenterol 2017; 112:1056-1060 doi: 10.1038/ajg.2017 RATIONALE AND CURRENT STATUS OF SURVEILLANCEAs survival in esophageal adenocarcinoma (EAC) is stage dependent, studies suggest that survival may be enhanced by endoscopic surveillance of Barrett's esophagus (BE), the only identifi able premalignant condition for this lethal cancer that continues to increase in incidence and is associated with a dismal 5-year survival rate. Current practice guidelines recommend endoscopic surveillance of patients with BE in an attempt to detect cancer at an early and potentially curable stage ( 1-3 ). Observational studies suggest that patients with BE in whom EAC was detected in a surveillance program have their cancers detected at an earlier stage with markedly improved 5-year survival compared with similar patients not undergoing routine surveillance ( 4-8 ).Variable results regarding the impact of surveillance in BE patients have been reported from four recent population-based studies. A large Northern Ireland population-based study and a large Dutch population-based study showed that in patients with EAC and a prior diagnosis of BE, survival was improved, and tumor stage and grade was lower compared with patients without a prior diagnosis of BE ( 9,10 ). Similarly, a cohort study of patients with BE diagnosed in the National Veterans Aff airs hospitals showed that surveillance endoscopy was associated with an early stage diagnosis of EAC, longer survival, and decreased overall and cancer-related mortality ( 11 ). On the other hand, a case-control study from the Northern California Kaiser Permanente population found no evidence that endoscopic surveillance improved survival from EAC ( 12 ). Despite these variable results and the lack of data from randomized controlled trials comparing surveillance vs. no surveillance (not likely to be performed in the future), surveillance of BE patients will continue to be recommended in clinical practice.Surveillance intervals are currently determined by the presence and grade of dysplasia. Several contemporary studies have demonstrated a low rate of progression to EAC in patients with non-dysplastic BE and this estimate ranges from 0.1-0.3% per year (13)(14)(15). Also, most patients with BE are likely to die of other causes, the commonest cause of deat...

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Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study

Abstract: The proportion of OAC patients with a prior diagnosis of BO is low; however, prior identification of BO is associated with an improvement in survival in OAC patients.

Cited by 131 publications

References 21 publications

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

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

Detection of dysplasia in Barrett’s oesophagus: Are there impending optical and spectroscopic solutions?

Editorial: Best Practices in Surveillance of Barrett's Esophagus

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