scholarly journals The role of ablation in the treatment of dysplastic Barrett’s esophagus

2021 ◽  
Vol 14 ◽  
pp. 263177452110499
Author(s):  
Rebecca Sullivan ◽  
Ramzi Mulki ◽  
Shajan Peter
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Eradication Therapy ◽  
Treatment Method ◽  
Primary Treatment ◽  
Complication Rates ◽  
High Definition ◽  
Early Esophageal Cancer ◽  
Treatment Interventions ◽  
Surveillance Programs

Endoscopic eradication therapy for Barrett’s esophagus has been established as an effective management strategy for patients with Barrett’s esophagus with dysplasia and early esophageal cancer. Among the endoscopic therapies, ablation techniques such as radiofrequency ablation and cryoablation are effective primary treatment interventions with acceptable low complication rates forming the spectrum of a multimodal approach. Appropriate selection of patients, high-definition endoscopic evaluation, and dedicated histological assessment are important cornerstones to help navigate to the best effective treatment method. Carefully structured surveillance programs and preventive measures will be needed to provide long-term durability for maintaining complete remission.

1005 A Detailed Analysis of the Depth and Orientation of Neo-Squamous Biopsy Specimens in Barrett's Esophagus (BE) Patients After Endoscopic Eradication Therapy (EET)

2013 ◽  
Vol 144 (5) ◽  
pp. S-187
Author(s):  
Maria Giacchino ◽  
Sharad C. Mathur ◽  
Vijay Kanakadandi ◽  
Gokulakrishnan Balasubramanian ◽  
Neil Gupta ◽  
...  
Keyword(s):  
Detailed Analysis ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Eradication Therapy ◽  
Biopsy Specimens

scholarly journals TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

2021 ◽  
Vol 09 (03) ◽  
pp. E348-E355
Author(s):  
David L. Diehl ◽  
Harshit S. Khara ◽  
Nasir Akhtar ◽  
Rebecca J. Critchley-Thorne
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Clinical Decision Making ◽  
Eradication Therapy ◽  
Low Risk ◽  
Management Approach ◽  
Low Grade ◽  
Management Decisions ◽  
The Impact

Abstract Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

Mo1110 Efficacy of Multimodality Endoscopic Eradication Therapy in the Treatment of Barrett's Esophagus (BE): A Systematic Review and Meta-Analysis

2014 ◽  
Vol 146 (5) ◽  
pp. S-559
Author(s):  
Shreyas Saligram ◽  
Matthew Hall ◽  
Prashanth Vennalaganti ◽  
Stefan Seewald ◽  
Alessandro Repici ◽  
...  
Keyword(s):  
Systematic Review ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Meta Analysis ◽  
Eradication Therapy

scholarly journals Endoscopic Mucosal Resection: Early Experience in British Columbia

2010 ◽  
Vol 24 (4) ◽  
pp. 239-244 ◽  
Author(s):  
Mayur Brahmania ◽  
Eric Lam ◽  
Jennifer Telford ◽  
Robert Enns
Keyword(s):  
British Columbia ◽  
Barrett’S Esophagus ◽  
Endoscopic Mucosal Resection ◽  
Barrett's Esophagus ◽  
Low Grade ◽  
Complication Rates ◽  
The Third ◽  
Mucosal Resection ◽  
The Mean

BACKGROUND: Endoscopic mucosal resection (EMR) has been proposed as a primary method of managing patients with dysplasia- or mucosal-based cancers of the esophagus.OBJECTIVES: To evaluate the use of EMR for the treatment of Barrett’s esophagus with dysplasia or early adenocarcinoma, assessing efficacy, complication rates and long-term outcomes.METHODS: All patients who underwent EMR at St Paul’s Hospital (Vancouver, British Columbia) were reviewed. Eligible patients were assessed with aggressive biopsy protocols. Detected cancers were staged with both endoscopic ultrasound imaging and computed tomography. Appropriate patients were offered EMR using a commercially available mucosectomy device. EMR was repeated at six- to eight-week intervals until complete. Patients with less than one year of follow-up or who were undergoing other ablative methods were excluded.RESULTS: Twenty-two patients (all men) with a mean (± SD) age of 67±10.6 years were identified. The mean duration of gastroesophageal reflux disease was 17 years (range four to 40 years) and all were receiving proton pump inhibitor therapy. The mean length of Barrett’s esophagus was 5.5±3.5 cm. One patient had no dysplasia (isolated nodule), three had low-grade dysplasia, 15 had high-grade dysplasia (HGD) and three had adenocarcinoma. A mean of 1.7±0.83 endoscopic sessions were performed, with a mean of 6±5.4 sections removed. Following EMR, three patients developed strictures; two of these patients had pre-existing strictures and the third required two dilations, which resolved his symptoms. There were no other complications. Three patients underwent esophagectomy. Two had adenocarcinoma or HGD in a pre-existing stricture. The third patient had an adenocarcinoma not amenable to EMR. One patient with a long segment of Barrett’s esophagus underwent radiofrequency ablation. At a median follow-up of two years (range one to three years), the remaining 18 patients (82%) had no evidence of HGD or cancer.CONCLUSION: Most patients with esophageal dysplasia can be managed with EMR. Individuals with pre-existing strictures require other endoscopic and/or surgical methods to manage their dysplasia or adenocarcinoma.

scholarly journals Systematic assessment with I-SCAN magnification endoscopy and acetic acid improves dysplasia detection in patients with Barrett’s esophagus

Endoscopy ◽  
2017 ◽  
Vol 49 (12) ◽  
pp. 1219-1228 ◽  
Author(s):  
Gideon Lipman ◽  
Raf Bisschops ◽  
Vinay Sehgal ◽  
Jacobo Ortiz-Fernández-Sordo ◽  
Rami Sweis ◽  
...  
Keyword(s):  
Acetic Acid ◽  
Barrett’S Esophagus ◽  
Classification System ◽  
Barrett's Esophagus ◽  
Narrow Band Imaging ◽  
Clinical Scenario ◽  
High Definition ◽  
Systematic Assessment ◽  
Magnification Endoscopy ◽  
Before And After

Abstract Background and study aims Enhanced endoscopic imaging with chromoendoscopy may improve dysplasia recognition in patients undergoing assessment of Barrett’s esophagus (BE). This may reduce the need for random biopsies to detect more dysplasia. The aim of this study was to assess the effect of magnification endoscopy with I-SCAN (Pentax, Tokyo, Japan) and acetic acid (ACA) on dysplasia detection in BE using a novel mucosal and vascular classification system. Methods BE segments and suspicious lesions were recorded with high definition white-light and magnification endoscopy enhanced using all I-SCAN modes in combination. We created a novel mucosal and vascular classification system based on similar previously validated classifications for narrow-band imaging (NBI). A total of 27 videos were rated before and after ACA application. Following validation, a further 20 patients had their full endoscopies recorded and analyzed to model use of the system to detect dysplasia in a routine clinical scenario. Results The accuracy of the I-SCAN classification system for BE dysplasia improved with I-SCAN magnification from 69 % to 79 % post-ACA (P = 0.01). In the routine clinical scenario model in 20 new patients, accuracy of dysplasia detection increased from 76 % using a “pull-through” alone to 83 % when ACA and magnification endoscopy were combined (P = 0.047). Overall interobserver agreement between experts for dysplasia detection was substantial (0.69). Conclusions A new I-SCAN classification system for BE was validated against similar systems for NBI with similar outcomes. When used in combination with magnification and ACA, the classification detected BE dysplasia in clinical practice with good accuracy.Trials registered at ISRCTN (58235785).

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