Endoscopic and histologic changes of Barretts esophageal mucosa complicated by histologic non-endoscopically visible unifocal high-grade dysplasia (HGD). A prospective follow up

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

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Risk of High-Grade Dysplasia and Cancer at Follow-up After Colorectal Endoscopic Mucosal Resection (EMR)

The American Journal of Gastroenterology ◽

10.14309/00000434-201510001-01338 ◽

2015 ◽

Vol 110 ◽

pp. S583

Author(s):

Bhaumik Brahmbhatt ◽

Abhishek Bhurwal ◽

Michael Bartel ◽

Jose Melendez ◽

Massimo Raimondo ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

High Grade Dysplasia ◽

High Grade ◽

Mucosal Resection

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Long-term follow-up of patients with Barrett esophagus: Progression to high-grade dysplasia and esophageal adenocarcinoma according to histology at presentation.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.20 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 20-20 ◽

Cited By ~ 1

Author(s):

Allon Kahn ◽

Vishnu Kommineni ◽

Jonathan Callaway ◽

Rahul Pannala ◽

David Fleischer ◽

...

Keyword(s):

Esophageal Adenocarcinoma ◽

Large Cohort ◽

High Grade Dysplasia ◽

Continuous Treatment ◽

Barrett Esophagus ◽

Low Grade ◽

High Grade ◽

Upper Endoscopy ◽

Early Stage Disease

20 Background: Esophageal adenocarcinoma (EAC) incidence is rising and prognosis is uniformly poor, even with early stage disease. Barrett esophagus (BE) serves as a premalignant marker for EAC, with an estimated progression of 0.5% per year. Low-grade (LGD) and high-grade dysplasia (HGD) confer a higher risk of progression, providing an opportunity for intervention and surveillance. Aims: To evaluate a large cohort of patients undergoing endoscopic evaluation of BE and thereby better understand the natural history of BE and dysplasia. Methods: A retrospective review of endoscopic databases was conducted for all patients with the diagnosis of BE undergoing upper endoscopy at a tertiary academic medical center from 1991-2010. All endoscopy and accompanying pathology reports were reviewed. Only those patients with 2 biopsies documenting specialized intestinal metaplasia were analyzed. Results: 848 patients underwent upper endoscopy for evaluation of BE. Of these, 674 patients met inclusion criteria, at a mean follow up of 66.6 months. Table 1 depicts the distribution of patients according to their histology at presentation. 22 (3.2%) patients presented with established EAC, while EAC developed in 51 (7.6%). Of patients with HGD, LGD, or no dysplasia (ND) at presentation, EAC ultimately developed in 30.6%, 6.6%, and 2.7%, respectively. EAC developed in 4 patients despite RFA treatment for ND (2) or LGD (2). HGD developed in 6 such patients after treatment for ND (3) and LGD (3). Only 1 patient in each RFA-treated cohort required esophagectomy, while the others cleared dysplasia or EAC with continuous treatment. Conclusions: In this large cohort of patients with Barrett’s esophagus, higher grade of dysplasia at first endoscopy was associated with development of EAC. Continuous surveillance during and after endoscopic treatment is necessary and often results in clearance of dysplasia and EAC. [Table: see text]

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Metachronous neoplasms in patients with laterally spreading tumours during surveillance

United European Gastroenterology Journal ◽

10.1177/2050640620965317 ◽

2020 ◽

pp. 205064062096531

Author(s):

Roel MM Bogie ◽

Bjorn Winkens ◽

Sean JJ Retra ◽

Chantal MC le Clercq ◽

Mariëlle W Bouwens ◽

...

Keyword(s):

Colorectal Neoplasms ◽

Colorectal Neoplasm ◽

Submucosal Invasion ◽

High Grade Dysplasia ◽

High Grade ◽

Age And Gender ◽

Metachronous Neoplasms ◽

Metachronous Colorectal Cancer ◽

And Gender

Background Laterally spreading tumours represent a major challenge for endoscopic detection and resection. Objective To examine synchronous and metachronous neoplasms in patients with laterally spreading tumours. Methods We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years’ follow-up. Post-resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared. Results Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, P < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, P = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, P < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients. Conclusion Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.

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Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection

BMC Gastroenterology ◽

10.1186/s12876-020-01499-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jia-Jang Chang ◽

Cheng-Hung Chien ◽

Shuo-Wei Chen ◽

Li-Wei Chen ◽

Ching-Jung Liu ◽

...

Keyword(s):

High Grade Dysplasia ◽

Advanced Adenoma ◽

Colon Polyps ◽

High Grade ◽

Colonic Adenoma ◽

Screen Colonoscopy ◽

Colon Adenomas ◽

Advanced Adenomas

Abstract Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44–5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

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