Tu1161 Clinical Outcomes Following Recurrence of Intestinal Metaplasia after Successful Treatment of Barrett’s Esophagus with Radiofrequency Ablation

Guthikonda, Athidi; Cotton, Cary C.; Madanick, Ryan D.; Spacek, Melissa; Moist, Susan E.; Ferrell, Kathleen; Dellon, Evan S.; Shaheen, Nicholas J.

doi:10.1016/j.gie.2016.03.1148

Cited by 2 publications

(3 citation statements)

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“…Two recent nationwide studies on long-term efficacy of EET have reported low recurrence risks during long-term surveillance after successful treatment for Barrett-related dysplasia/EAC 115 170 . The majority of recurrences were detected in the first 2 years after successful treatment, varying between (on average) 12 and 31 months after treatment 115 170 175 176 179 , leading to our recommendation for less aggressive surveillance in the first year after successful EET ( Fig. 3 ).…”

Section: Management After Endoscopic Eradication Therapy Of Bementioning

confidence: 97%

“…Given that the diagnostic yield of biopsies appears to be minimal in expert hands, random quadrant biopsies of the proximal cardia have been abandoned in some expert centers 178 . However, as the neo-squamocolumnar junction can be difficult to assess endoscopically and because this is a site where visible and invisible recurrences can occur, we recommend that, in centers with no expertise in EET, quadrant biopsies are taken just distal to the neo-squamocolumnar junction to rule out invisible dysplasia, which may require additional treatment or stricter follow-up 170 176 179 .…”

Section: Management After Endoscopic Eradication Therapy Of Bementioning

confidence: 99%

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Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Weusten,

Bisschops,

Dinis-Ribeiro

et al. 2023

Endoscopy

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Main Recommendations MR1 ESGE recommends the following standards for Barrett esophagus (BE) surveillance:– a minimum of 1-minute inspection time per cm of BE length during a surveillance endoscopy– photodocumentation of landmarks, the BE segment including one picture per cm of BE length, and the esophagogastric junction in retroflexed position, and any visible lesions– use of the Prague and (for visible lesions) Paris classification– collection of biopsies from all visible abnormalities (if present), followed by random four-quadrant biopsies for every 2-cm BE length.Strong recommendation, weak quality of evidence. MR2 ESGE suggests varying surveillance intervals for different BE lengths. For BE with a maximum extent of ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE with a maximum extent of ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent of ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies. For patients with an irregular Z-line/columnar-lined esophagus of < 1 cm, no routine biopsies or endoscopic surveillance are advised.Weak recommendation, low quality of evidence. MR3 ESGE suggests that, if a patient has reached 75 years of age at the time of the last surveillance endoscopy and/or the patient’s life expectancy is less than 5 years, the discontinuation of further surveillance endoscopies can be considered. Weak recommendation, very low quality of evidence. MR4 ESGE recommends offering endoscopic eradication therapy using ablation to patients with BE and low grade dysplasia (LGD) on at least two separate endoscopies, both confirmed by a second experienced pathologist.Strong recommendation, high level of evidence. MR5 ESGE recommends endoscopic ablation treatment for BE with confirmed high grade dysplasia (HGD) without visible lesions, to prevent progression to invasive cancer.Strong recommendation, high level of evidence. MR6 ESGE recommends offering complete eradication of all remaining Barrett epithelium by ablation after endoscopic resection of visible abnormalities containing any degree of dysplasia or esophageal adenocarcinoma (EAC).Strong recommendation, moderate quality of evidence. MR7 ESGE recommends endoscopic resection as curative treatment for T1a Barrett’s cancer with well/moderate differentiation and no signs of lymphovascular invasion.Strong recommendation, high level of evidence. MR8 ESGE suggests that low risk submucosal (T1b) EAC (i. e. submucosal invasion depth ≤ 500 µm AND no [lympho]vascular invasion AND no poor tumor differentiation) can be treated by endoscopic resection, provided that adequate follow-up with gastroscopy, endoscopic ultrasound (EUS), and computed tomography (CT)/positrion emission tomography-computed tomography (PET-CT) is performed in expert centers.Weak recommendation, low quality of evidence. MR9 ESGE suggests that submucosal (T1b) esophageal adenocarcinoma with deep submucosal invasion (tumor invasion > 500 µm into the submucosa), and/or (lympho)vascular invasion, and/or a poor tumor differentiation should be considered high risk. Complete staging and consideration of additional treatments (chemotherapy and/or radiotherapy and/or surgery) or strict endoscopic follow-up should be undertaken on an individual basis in a multidisciplinary discussion.Strong recommendation, low quality of evidence. MR10 a ESGE recommends that the first endoscopic follow-up after successful endoscopic eradication therapy (EET) of BE is performed in an expert center.Strong recommendation, very low quality of evidence. b ESGE recommends careful inspection of the neo-squamocolumnar junction and neo-squamous epithelium with high definition white-light endoscopy and virtual chromoendoscopy during post-EET surveillance, to detect recurrent dysplasia.Strong recommendation, very low level of evidence. c ESGE recommends against routine four-quadrant biopsies of neo-squamous epithelium after successful EET of BE.Strong recommendation, low level of evidence. d ESGE suggests, after successful EET, obtaining four-quadrant random biopsies just distal to a normal-appearing neo-squamocolumnar junction to detect dysplasia in the absence of visible lesions.Weak recommendation, low level of evidence. e ESGE recommends targeted biopsies are obtained where there is a suspicion of recurrent BE in the tubular esophagus, or where there are visible lesions suspicious for dysplasia.Strong recommendation, very low level of evidence. MR11 After successful EET, ESGE recommends the following surveillance intervals:– For patients with a baseline diagnosis of HGD or EAC:at 1, 2, 3, 4, 5, 7, and 10 years after last treatment, after which surveillance may be stopped.– For patients with a baseline diagnosis of LGD:at 1, 3, and 5 years after last treatment, after which surveillance may be stopped.Strong recommendation, low quality of evidence.

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Section: Management After Endoscopic Eradication Therapy Of Bementioning

confidence: 97%

Section: Management After Endoscopic Eradication Therapy Of Bementioning

confidence: 99%

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Weusten,

Bisschops,

Dinis-Ribeiro

et al. 2023

Endoscopy

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“…Auch nach ER und kompletter Ablation der Barrettmukosa kommt es zu Rezidiven von Barrett-Mukosa und -Dysplasien 463 464 465 . Da diese Rezidive oftmals einer erneuten endoskopischen Therapie zugänglich sind, sollten auch nach kompletter Ablation der Barrettmukosa Kontroll-Endoskopien in regelmäßigen Abständen erfolgen.…”

Section: Leitlinie – Barrett-ösophagusunclassified

S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013

2023

Z Gastroenterol

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Tu1161 Clinical Outcomes Following Recurrence of Intestinal Metaplasia after Successful Treatment of Barrett’s Esophagus with Radiofrequency Ablation

Cited by 2 publications

References 0 publications

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013

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