Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus

Badreddine, Rami J.; Prasad, Ganapathy A.; Wang, Kenneth K.; Song, Louis M. Wong Kee; Buttar, Navtej; Dunagan, Kelly T.; Lutzke, Lori S.; Borkenhagen, Lynn S.

doi:10.1016/j.gie.2009.08.031

Cited by 52 publications

(37 citation statements)

References 35 publications

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“…Cohorts treated with either combination therapy (EMR followed by ablation) ( 178 ) or single modality therapy (EMR alone) ( 173 ) have reported comparable recurrence rates. Recurrence rates also appear to be similar across diff erent ablation modalities, with similar rates being described following cryotherapy ( 168 ) and photodynamic therapy for the treatment of dysplastic BE ( 179 ). Careful endoscopic surveillance with biopsies is hence recommended following CEIM to detect recurrent IM.…”

Section: Summary Of Evidencementioning

confidence: 83%

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: 83%

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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“…Therefore, since HGD is not associated with metastatic nodal spread when the existence of a deeper invasion has been excluded by EMR, endoscopic treatment is preferred over surgery in most patients with BE and HGD [32,33,3840] . But, on the other hand, endoscopic therapies are associated with a higher rate of recurrence of the HGD [3234,38,41] , although it can usually be treated endoscopically [3234,42] . Because of that, surgical resection should be reserved until the endoscopic treatment fails [3234] .…”

Section: Hgd and Intramucosal Eamentioning

confidence: 99%

“…RFA ablation is a safe, long Among alternative ablative techniques, PDT has been effectively used to ablate HGD, reducing the risk of progression to cancer compared with surveillance alone [64] . However, adverse events associated with this technology are common (development of esophageal stricture, 36% after PDT vs 6% after RFA) and may be severe [22,42] . Moreover, HGD can even persist in up to 33%50% of the patients [65,66] .…”

Section: Hgd and Intramucosal Eamentioning

confidence: 99%

Update on management of Barrett's esophagus

Macias-García

Domínguez–Muñoz

2016

WJGPT

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develops as a consequence of gastroesophageal reflux disease. The significance of Barrett's metaplasia is that predisposes to cancer development. This article provides a current evidence-based review for the management of BE and related early neoplasia. Controversial issues that impact the management of patients with BE, including definition, screening, clinical aspects, diagnosis, surveillance, and management of dysplasia and early cancer have been assessed. Core tip: Barrett's esophagus (BE) is a common condition that predisposes to cancer development. This article provides a current evidence-based review for controversial issues that impact the management of patients with BE, including clinical aspects, diagnosis, surveillance, and management of dysplasia and early cancer. Macías-García INTRODUCTIONSince Barrett's esophagus (BE) was first described in 1950 [1] , the definition of this condition has been modified on several occasions. Presently, it is defined as the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer develop ment replaces the stratified squamous epithelium that normally lines the distal esophagus [2] . AbstractBarrett's esophagus (BE) is a common condition that MINIREVIEWSSubmit a

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“…Over the past 15 years many ablative modalities have been developed, with various outcomes. 8 All of these methods ablate tissue without the benefit of histological specimen retrieval. [9][10][11][12][13] Their aim is to destroy the metaplastic/ dysplastic epithelium, which will then be replaced, in non-acid environments, by squamous epithelium.…”

Section: Introductionmentioning

confidence: 99%

Sixteen‐year follow‐up of Barrett's esophagus, endoscopically treated with argon plasma coagulation

et al. 2014

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Objective: The thermal destruction of non-dysplastic Barrett's esophagus (BE) and its replacement by squamous epithelium is an attractive, but unproven strategy to avoid further development of dysplasia or cancer. The goal of this study was to estimate the persistence of restoration of squamous epithelium and the risk of cancer in BE that was eradicated using argon plasma coagulation (APC) in the absence of high-grade dysplasia, 16 years after its application. Design: We followed 32 patients with BE who underwent eradication of metaplastic epithelium using APC, up to 16 years later. Results: At the end of the initial treatment, 25 of 32 patients (78%) had complete endoscopic eradication, there was partial squamous re-epithelialization in four patients (13%) and it was absent in three patients (9%). We observed buried metaplastic glands under new squamous epithelium in 6 of the 25 patients who had complete endoscopic eradication. At followup, sustained complete endoscopic eradication was observed in 16 of 32 patients (50%), partial eradication in 11 of 32 patients (35%); there were two patients (6%) lost to follow-up and three patients (9%) developed esophageal adenocarcinoma. Two of the latest cases arose from the buried glands under neosquamous epithelium after complete eradication and one arose from a small remaining Barrett's segment. Conclusions: We observed long-term re-epithelialization in the majority of patients who had previously had complete eradication of Barrett's esophagus. This did not provide protection against cancer development, as the incidence of cancers arising from buried glands or from residual Barrett's esophagus was similar to that observed in patients undergoing no specific treatment.

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Prevalence and predictors of recurrent neoplasia after ablation of Barrett's esophagus

Abstract: Background-The incidence and risk factors for recurrence of dysplasia after ablation of Barrett's esophagus (BE) have not been well defined.

Cited by 52 publications

References 35 publications

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

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

Update on management of Barrett's esophagus

Sixteen‐year follow‐up of Barrett's esophagus, endoscopically treated with argon plasma coagulation

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