scholarly journals Implications of Recent Revelations from Basic and Clinical Studies of Barrett’s Esophagus for Screening and Surveillance Strategies

2021 ◽  
Vol 1 (1) ◽  
pp. 86-92
Author(s):  
Stuart Jon Spechler ◽  
Rhonda F. Souza
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Prevention Strategies ◽  
Endoscopic Screening ◽  
Screening Practices ◽  
The Past ◽  
Screening And Surveillance ◽  
Gerd Symptoms ◽  
Current Screening

During the past several decades, while the incidence of esophageal adenocarcinoma (EAC) has risen dramatically, our primary EAC-prevention strategies have been endoscopic screening of individuals with GERD symptoms for Barrett’s esophagus (BE), and endoscopic surveillance for those found to have BE. Unfortunately, current screening practices have failed to identify most patients who develop EAC, and the efficacy of surveillance remains highly questionable. We review potential reasons for failure of these practices including recent evidence that most EACs develop through a rapid genomic doubling pathway, and recent data suggesting that many EACs develop from segments of esophageal intestinal metaplasia too short to be recognized as BE. We highlight need for a biomarker to identify BE patients at high risk for neoplasia (who would benefit from early therapeutic intervention), and BE patients at low risk (who would not benefit from surveillance). Promising recent efforts to identify such a biomarker are reviewed herein.

scholarly journals A Practical Approach to Screening and Surveillance of Barrett’s Esophagus

2021 ◽  
Vol 1 (1) ◽  
pp. 25-31
Author(s):  
Srinadh Komanduri ◽  
Domenico A. Farina
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
New Technologies ◽  
Endoscopic Surveillance ◽  
Segment Length ◽  
Innovative Technology ◽  
High Morbidity ◽  
Endoscopic Screening ◽  
Screening Practices ◽  
Screening And Surveillance

Barrett’s esophagus (BE) can progress to Esophageal Adenocarcinoma (EAC), which has associated high morbidity and mortality. As such, societal guidelines suggest endoscopic screening in select individuals with multiple BE risk factors. However, cheaper and less invasive new technologies may allow for more widespread BE screening practices in the future. In patients with established BE, endoscopic surveillance is recommended with intervals based primarily on histology and to a lesser degree, BE segment length. Similar to BE screening, endoscopic surveillance can further be optimized with improved techniques, innovative technology, and further understanding of risk stratification for EAC.

scholarly journals Chemoprevention in Barrett’s esophagus and esophageal adenocarcinoma

2021 ◽  
Vol 14 ◽  
pp. 175628482110337
Author(s):  
Motasem Alkhayyat ◽  
Prabhat Kumar ◽  
Krishna O. Sanaka ◽  
Prashanthi N. Thota
Keyword(s):  
Barrett’S Esophagus ◽  
Esophageal Adenocarcinoma ◽  
Barrett's Esophagus ◽  
Controlled Trial ◽  
Early Esophageal Cancer ◽  
Substantial Impact ◽  
Randomized Controlled ◽  
The Past ◽  
Incidence Of Cancer ◽  
Screening And Surveillance

There has been a dramatic increase in the incidence of Barrett’s esophagus and esophageal adenocarcinoma over the past several decades with a continued rise expected in the future. Several strategies have been developed for screening and surveillance of patients with Barrett’s esophagus and endoscopic treatment of Barrett’s associated dysplasia and early esophageal cancer; however, they have not made a substantial impact on the incidence of cancer. Herein, chemoprevention becomes an attractive idea for reducing the incidence of cancer in Barrett’s patients. Several agents appear promising in preclinical and observational studies but very few have been evaluated in randomized controlled trials. Strongest evidence to date is available for proton-pump inhibitors and Aspirin that have been evaluated in a large randomized controlled trial. Other agents such as statins, metformin, ursodeoxycholic acid, and dietary supplements have insufficient evidence for chemoprevention in Barrett’s patients.

Evaluation of Barrett's Esophagus

2021 ◽  
Author(s):  
Trent Walradt ◽  
Mohammad Bilal ◽  
Douglas K. Pleskow
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Barrett’S Esophagus ◽  
Esophageal Adenocarcinoma ◽  
Reflux Disease ◽  
Barrett's Esophagus ◽  
Squamous Epithelium ◽  
The Past ◽  
Screening And Surveillance ◽  
Stratified Squamous Epithelium

AbstractBarrett's esophagus (BE) is the condition in which a metaplastic columnar epithelium that is predisposed to malignancy replaces the stratified squamous epithelium that normally lines the distal esophagus. BE develops as a consequence of chronic gastroesophageal reflux disease and predisposes to esophageal adenocarcinoma (EAC). Several societal guidelines recommend screening and surveillance for BE to reduce the risk of EAC and its related morbidity and mortality. Even among persons undergoing screening and surveillance, a substantial proportion of cases of EAC can be missed. Consequently, the armamentarium for the evaluation of BE has expanded rapidly over the past decade. In this article, we summarize the pathophysiology and diagnosis of BE. We also discuss the latest advancements in the evaluation of BE.

scholarly journals Genetic variants in Barrett's esophagus and esophageal adenocarcinoma: a literature review

2019 ◽  
Vol 32 (8) ◽  
Author(s):  
Zachary M Callahan ◽  
Zhuqing Shi ◽  
Bailey Su ◽  
Jianfeng Xu ◽  
Michael Ujiki
Keyword(s):  
Barrett’S Esophagus ◽  
Esophageal Adenocarcinoma ◽  
Barrett's Esophagus ◽  
Association Studies ◽  
Genetic Alterations ◽  
Genome Wide Association Studies ◽  
Endoscopic Screening ◽  
Genome Wide ◽  
Current Screening

SUMMARY Surveillance of Barrett's esophagus (BE) is a clinical challenge; metaplasia of the distal esophagus increases a patient's risk of esophageal adenocarcinoma (EAC) significantly but the actual percentage of patients who progress is low. The current screening recommendations require frequent endoscopy and biopsy, which has inherent risk, high cost, and operator variation. Identifying BE patients genetically who are at high risk of progressing could deemphasize the role of endoscopic screening and create an opportunity for early therapeutic intervention. Genetic alterations in germline DNA have been identified in other disease processes and allow for early intervention or surveillance well before disease develops. The genetic component of BE remains mostly unknown and only a few genome-wide association studies exist on this topic. This review summarizes the current literature available that examines genetic alterations in BE and EAC with a particular emphasis on clinical implications.

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.

scholarly journals Risk Prediction of Barrett’s Esophagus in a Taiwanese Health Examination Center Based on Regression Models

2021 ◽  
Vol 18 (10) ◽  
pp. 5332
Author(s):  
Po-Hsiang Lin ◽  
Jer-Guang Hsieh ◽  
Hsien-Chung Yu ◽  
Jyh-Horng Jeng ◽  
Chiao-Lin Hsu ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Risk Prediction ◽  
Barrett's Esophagus ◽  
Gastrointestinal Endoscopy ◽  
Prediction Models ◽  
Upper Gastrointestinal Endoscopy ◽  
Health Examination ◽  
Endoscopic Screening ◽  
Risk Prediction Models ◽  
Upper Gastrointestinal

Determining the target population for the screening of Barrett’s esophagus (BE), a precancerous condition of esophageal adenocarcinoma, remains a challenge in Asia. The aim of our study was to develop risk prediction models for BE using logistic regression (LR) and artificial neural network (ANN) methods. Their predictive performances were compared. We retrospectively analyzed 9646 adults aged ≥20 years undergoing upper gastrointestinal endoscopy at a health examinations center in Taiwan. Evaluated by using 10-fold cross-validation, both models exhibited good discriminative power, with comparable area under curve (AUC) for the LR and ANN models (Both AUC were 0.702). Our risk prediction models for BE were developed from individuals with or without clinical indications of upper gastrointestinal endoscopy. The models have the potential to serve as a practical tool for identifying high-risk individuals of BE among the general population for endoscopic screening.

T1887 Development of Biomarkers for Non-Endoscopic Screening for Barrett's Esophagus

2009 ◽  
Vol 136 (5) ◽  
pp. A-593-A-594
Author(s):  
Sudarshan R. Kadri ◽  
Madhumita Das ◽  
Pierre Lao-Sirieix ◽  
Maria O'Donovan ◽  
Irene Debiram ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Endoscopic Screening
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