scholarly journals Liquid nitrogen spray cryotherapy-based multimodal endoscopic management of dysplastic Barrett’s esophagus and early esophageal neoplasia: retrospective review and long-term follow-up at an academic tertiary care referral center

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
Vivek Kaul ◽  
Krystle Bittner ◽  
Asad Ullah ◽  
Shivangi Kothari
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Segment Length ◽  
Single Center ◽  
Esophageal Neoplasia ◽  
Complete Eradication

Summary Background Endoscopic eradication therapy of dysplastic Barrett’s esophagus (BE) and early esophageal neoplasia has emerged as an effective treatment option. Data for the role of spray cryotherapy (SCT) in this setting is relatively limited. Objective To evaluate the safety and long-term outcomes of SCT-based multimodal therapy in the management of dysplastic BE and early esophageal neoplasia. Design Single-center, retrospective, cohort study. Setting Academic, tertiary care center between August 2008 and February 2019. Methods A retrospective chart review was conducted of the prospectively maintained endoscopic cryotherapy database at our center. Fifty-seven patients were identified who underwent SCT treatment for dysplastic BE and esophageal or Gastro-esophageal (GE) junction adenocarcinoma during the study period. Primary outcome was complete eradication of intestinal metaplasia (CE-IM); secondary outcome was complete eradication of dysplasia (CE-D). Results A total of 171 SCT procedures were performed in 57 patients. The majority of patients were male (89.5%) with long-segment BE (93%; mean segment length 6.2 cm). Complete follow-up data was available for 56 of these 57 patients. 43.9% (25/57) of patients underwent radiofrequency ablation (RFA) during the course of treatment (e.g. after initiating SCT). 33.3% of patients (19/57) were RFA failures prior to SCT. Additionally, 68.4% (39/57) of patients underwent endoscopic resection (EMR) prior to SCT as part of our multimodal approach to treatment of BE dysplasia/neoplasia. Four patients (7%) are currently undergoing active ablation and/or EMR treatment. CE-IM was achieved in 75% (39/52) of patients, and CE-D in 98.1% (51/52). Mean duration of overall follow-up was 4.8 years, with mean CE-IM durability of 2.6 years. Limitations Single-center only, retrospective study design. Conclusion SCT-based multimodal endoscopic therapy can achieve very high CE-IM (75%) and CE-D (>98%) rates in a high-risk population with esophageal dysplasia and/or neoplasia.

Clinical pathways and outcomes of patients with Barrett’s esophagus in tertiary care settings: a prospective longitudinal cohort study in Australia, 2008–2016

2020 ◽  
Author(s):  
Renhua Na ◽  
Kyoko Miura ◽  
Suzanne O’Brien ◽  
Guy D Eslick ◽  
Bradley J Kendall ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Clinical Pathways ◽  
Tertiary Care ◽  
Incidence Rates ◽  
Segment Length ◽  
Low Grade ◽  
Adjusted Incidence ◽  
Prospective Longitudinal

Summary Background Clinical services for Barrett’s esophagus have been rising worldwide including Australia, but little is known of the long-term outcomes of such patients. Retrospective studies using data at baseline are prone to both selection and misclassification bias. We investigated the clinical characteristics and outcomes of Barrett’s esophagus patients in a prospective cohort. Methods We recruited patients diagnosed with Barrett’s esophagus in tertiary settings across Australia between 2008 and 2016. We compared baseline and follow-up epidemiological and clinical data between Barrett’s patients with and without dysplasia. We calculated age-adjusted incidence rates and estimated minimally and fully adjusted hazard ratios (HR) to identify those clinical factors related to disease progression. Results The cohort comprised 268 patients with Barrett’s esophagus (median follow-up 5 years). At recruitment, 224 (84%) had no dysplasia, 44 (16%) had low-grade or indefinite dysplasia (LGD/IND). The age-adjusted incidence of esophageal adenocarcinoma (EAC) was 0.5% per year in LGD/IND compared with 0.1% per year in those with no dysplasia. Risk of progression to high-grade dysplasia/EAC was associated with prior LGD/IND (fully adjusted HR 6.55, 95% confidence interval [CI] 1.96–21.8) but not long-segment disease (HR 1.03, 95%CI 0.29–3.58). Conclusions These prospective data suggest presence of dysplasia is a stronger predictor of progression to cancer than segment length in patients with Barrett’s esophagus.

Long-term Follow-up After Anti-reflux Surgery in Patients with Barrett’s Esophagus

2010 ◽  
Vol 14 (10) ◽  
pp. 1483-1491 ◽  
Author(s):  
Joerg Zehetner ◽  
Steven R. DeMeester ◽  
Shahin Ayazi ◽  
Jesse L. Costales ◽  
Florian Augustin ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Long Term Follow Up

Neoplastic Progression in Patients with Short Segment Barrett's Esophagus: Long-Term Follow-up of Over a 1000 Patients in a Multi-Center Consortium

2017 ◽  
Vol 152 (5) ◽  
pp. S456
Author(s):  
Sreekar Vennelaganti ◽  
Sravanthi Parasa ◽  
Prashanth Vennalaganti ◽  
Srinivas Gaddam ◽  
Manon Spaander ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Neoplastic Progression ◽  
Short Segment ◽  
Long Term Follow Up

Reflux, Sleeve Dilation, and Barrett’s Esophagus after Laparoscopic Sleeve Gastrectomy: Long-Term Follow-Up

2017 ◽  
Vol 27 (12) ◽  
pp. 3092-3101 ◽  
Author(s):  
Daniel Moritz Felsenreich ◽  
Ronald Kefurt ◽  
Martin Schermann ◽  
Philipp Beckerhinn ◽  
Ivan Kristo ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Long Term Follow Up
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