The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program

Shaheen, Nicholas J.; Green, Bryan; Medapalli, Raj K.; Mitchell, Kate; Wei, Jiann-Wu; Schmitz, Sarah; West, Lindsay; Brown, Alphonso; Noble, Marc D.; Sultan, Shahnaz; Provenzale, Dawn

doi:10.1053/j.gastro.2005.05.055

Cited by 18 publications

(30 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These data, which confirm multiple other studies demonstrating both the low cancer risk in these patients and the tendency of Barrett's esophagus patients to die of cardiopulmonary disease and not from esophageal adenocarcinoma, should put to rest any rationale for considering widespread application of RFA for nondysplastic Barrett's esophagus [16]. Furthermore, it is important to remember that patients routinely are unable to accurately assess their own cancer risk and hence justification for such an intervention [17].…”

Section: Cancer Risk For a Given Patient With Barrett's Esophagus Is supporting

confidence: 70%

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

Falk

2010

Dig Dis Sci

View full text Add to dashboard Cite

Section: Cancer Risk For a Given Patient With Barrett's Esophagus Is supporting

confidence: 70%

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

Falk

2010

Dig Dis Sci

View full text Add to dashboard Cite

Section: Summary Of Evidencementioning

confidence: 99%

“…First, wide access to the Internet allows patients to obtain information about BE and EAC in an unfi ltered manner. Studies to date suggest that patients both over-and under-estimate their cancer risk ( 16,104 ). Given the low risk of progression to cancer for most patients with BE and the data suggesting that most BE patients die of causes other than EAC, such counseling should now be part of the ongoing care of these patients to help inform decision making regarding therapeutic options ( 65 ).…”

Section: Summary Of the Evidencementioning

confidence: 99%

“…Despite the incompletely elucidated risk of EAC in non-IM CLE, and acknowledging the potential for sampling error, we continue to suggest that only CLE containing IM be defi ned as BE, given the apparent diff erential cancer risk between CLE containing IM and CLE without IM. Until and unless further work substantiates a markedly elevated risk of EAC in non-IM CLE patients, it is unwise to give these patients a disease diagnosis that has a documented negative impact on insurance status and quality of life ( 16,17 ).IM of cardia is very common, being described in up to 20% of asymptomatic subjects presenting for routine open access endoscopic examinations ( 18 ). Studies have suggested that IM of the cardia is not more common in BE patients compared with controls ( 19 ), and that the natural history of IM at the EGJ is associated with Helicobacter pylori infection and not associated with EAC ( 20 ).…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,355

1,412

View full text Add to dashboard Cite

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 ...

show abstract

“…Many interventions are associated with adverse events, and the overdiagnosis of cancer can result in harm to a subset of patients who would not have suffered from cancer (7). Other potential harms of overdiagnosis are more subtle and include unnecessary fear of dying or suffering from cancer and the real loss of, limitations to, or increased premiums for health care insurance (8,9). Accurate cancer risk biomarkers could provide evidence to reassure low-risk patients that they do not need an intervention, in addition to identifying high-risk patients for whom interventions can increase longevity.…”

mentioning

confidence: 99%

Cancer Risk Assessment and Cancer Prevention: Promises and Challenges

Reid

2008

Cancer Prevention Research

View full text Add to dashboard Cite

The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program

Abstract: The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.

Cited by 18 publications

References 28 publications

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

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

Cancer Risk Assessment and Cancer Prevention: Promises and Challenges

Contact Info

Product

Resources

About