Review: Diagnosis and management of Barrett’s esophagus for the endoscopist

Garud, Sagar; Keilin, Steven; Cai, Qiang; Willingham, Field F.

doi:10.1177/1756283x10365439

Cited by 33 publications

(26 citation statements)

References 83 publications

(88 reference statements)

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“…In a prospective randomized trial, both "cap-and-snare" and "band-and-snare" technique can provide adequate depth and histological staging and have similar safety profies [176,177]. Studies have demonstrated that EMR is safe and effective for the treatment of superficial lesions for successful eradication of BE with varied degree of dysplasia and IMC [169,178,179]. Five-year follow-up data for 231 BE patients with IMC demonstrated a 95.7% complete response rate [180].…”

Section: Non Ablative Modalities (Endoscopic Resection-emr)mentioning

confidence: 99%

“…Because of that Japanese Society for Gastrointestinal Endoscopy (JSGE) recomended using of EMR only for HGD lesions, involving less than one-third of the circumference of the esophageal wall [179]. Regarding length of BE, recent observational studies reported good results when segments of BE more than 2 cm or flat mucosal lesions can be resected by CBE_EMR [170,172,178]. SRER is mostly limited to a 5-cm Barrett's segment [189].…”

Section: Non Ablative Modalities (Endoscopic Resection-emr)mentioning

confidence: 99%

“…Because of that stricture formation was observed in nearly half of cases [132]. The role of this method in long-segment BE with HGD is still limited, and is generally not widely recommended at this time [171,172,178].…”

Section: Non Ablative Modalities (Endoscopic Resection-emr)mentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

Vladimirov¹,

Ivanova²,

Terziev³

2013

Endoscopy of GI Tract

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Section: Non Ablative Modalities (Endoscopic Resection-emr)mentioning

confidence: 99%

Section: Non Ablative Modalities (Endoscopic Resection-emr)mentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

Vladimirov¹,

Ivanova²,

Terziev³

2013

Endoscopy of GI Tract

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“…Conservative management, involving symptom control and periodic endoscopic surveillance to exclude progressive disease, is recommended for patients with Barrett’s esophagus without evidence of dysplasia or cancer. Lifestyle modifications can be helpful to increase esophageal acid clearance and decrease the incidence of reflux events [41]. …”

Section: What Do We Know About Unmet Needs?mentioning

confidence: 99%

Pharmaceutical Principles of Acid Inhibitors: Unmet Needs

Krznarić

Kelečić²,

Rustemović³

et al. 2011

Dig Dis

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Despite the well-established benefits of currently approved delayed-release proton pump inhibitors (PPIs) in the treatment of acid-related diseases, the unmet needs are still present and although often frustrating, they challenge clinicians. The unmet needs relate to the lack of complete control of acid secretion with oral PPI administration in the management of patients with gastroesophageal symptoms. These substantial groups of patients, who do not respond completely to standard doses of PPIs, are nonresponders, and their lack of response should be considered as PPI failure. Several mechanisms could explain PPI failure: differences in pharmacokinetics, PPI formulation, dosing time and diet, noncompliance, transient lower esophageal sphincter relaxations, esophageal hypersensitivity, and nocturnal acid breakthrough. To increase the quality of life of these patients and avoid multiple medical consultations and unnecessary investigations, we have to go one step forward and use combined therapy or look towards new treatments beyond acid suppression.

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“…Barrett's esophagus (BE) is a change in the distal esophageal epithelium of any length that can be recognized as columnar‐lined mucosa at endoscopy and is confirmed to have intestinal metaplasia (IM) by biopsy of the tubular esophagus . BE is a precursor for the development of esophageal adenocarcinoma (EAC) via a pathway that begins with goblet‐cell metaplasia, followed by dysplasia and eventually EAC . The risk of progression to EAC in nondysplastic BE is estimated to be 0.12–0.5% per patient per year .…”

Section: Introductionmentioning

confidence: 99%

Dysplasia detection rate of confirmatory EGD in nondysplastic Barrett's esophagus

et al. 2012

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Current guidelines for endoscopic surveillance of Barrett's esophagus (BE) recommend that patients with newly diagnosed BE undergo confirmatory esophagogastroduodenoscopy (EGD) to exclude the presence of dysplasia. The extent to which confirmatory endoscopy alters management and detects missed dysplasia in newly diagnosed BE has not been reported. The frequency with which confirmatory endoscopy changed surveillance management in patients with newly diagnosed BE was assessed. A two center cohort analysis was conducted on patients newly diagnosed with BE. The rate of dysplasia on confirmatory endoscopy for patients who had nondysplastic BE was obtained. Demographic and endoscopic variables were assessed for association with dysplasia detection using Firth logistic regression model. Out of the 146 patients newly diagnosed with BE and initially determined to be without dysplasia, 12 had dysplasia on the confirmatory second EGD (8.2%). Eleven of 12 cases with dysplasia on confirmatory endoscopy had long-segment BE (LSBE). Among all the LSBE cases in our cohort, 11 had newly diagnosed dysplasia on confirmatory EGD, 29.7% (11/37). The average number of biopsies obtained from the 11 LSBE cases with dysplasia was comparable with the rest of the LSBE cases without dysplasia (6.73 and 5.42, respectively, P-value 0.205). The rate of dysplasia detection in short-segment BE (SSBE) was much lower, 0.95% (1 out of 105). There were no cases of high-grade dysplasia (HGD) or cancer detected in any SSBE case. HGD was detected on confirmatory EGD in two cases, both were LSBE. Segment length was the only statistically significant factor to predict the presence of dysplasia on confirmatory endoscopy (odds ratio 9.158, P. 0.008). Confirmatory EGD in newly diagnosed LSBE had significant rate of dysplasia detection (29.7%) in this cohort. Among patients with SSBE, there was a low rate of dysplasia detection with confirmatory EGD, less than 1% of cases. No additional cases of HGD or esophageal carcinoma in SSBE cases were detected. This suggests that the yield of confirmatory EGD is greater in patients with LSBE.

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Review: Diagnosis and management of Barrett’s esophagus for the endoscopist

Cited by 33 publications

References 83 publications

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia

Pharmaceutical Principles of Acid Inhibitors: Unmet Needs

Dysplasia detection rate of confirmatory EGD in nondysplastic Barrett's esophagus

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