State of the Art: Management of Barrett’s Esophagus Related Dysplasia and Neoplasia—Which Patient and What Therapy?

2021 ◽  
Vol 1 (1) ◽  
pp. 68-77
Author(s):  
Lovekirat Dhaliwal ◽  
Prasad G. Iyer
Keyword(s):  
Complete Remission ◽  
Endoscopic Submucosal Dissection ◽  
Barrett’S Esophagus ◽  
Endoscopic Resection ◽  
Barrett's Esophagus ◽  
State Of The Art ◽  
Gastroesophageal Junction ◽  
Eradication Therapy ◽  
Ablative Therapies ◽  
Early Adenocarcinoma

Endoscopic eradication therapy (EET) is safe and effective in the management of Barrett’s esophagus (BE) related dysplasia and early adenocarcinoma. EET includes endoscopic resection of the visible lesions followed by ablation to eradicate the residual Barrett’s epithelium. Techniques available for endoscopic resection include cap-based endoscopic mucosal resection and endoscopic submucosal dissection. Ablative therapies such as RFA, cryoablation and APC are used for the eradication of dysplastic BE and to prevent progression to EAC. Complete remission of intestinal metaplasia is the goal of EET. Post-treatment endoscopic surveillance is recommended to detect recurrence of metaplasia/dysplasia, mostly at the gastroesophageal junction.

scholarly journals Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 317-325 ◽  
Author(s):  
Joke Vliebergh ◽  
Pierre Deprez ◽  
Danny de Looze ◽  
Marc Ferrante ◽  
Hans Orlent ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Complete Remission ◽  
Barrett’S Esophagus ◽  
Endoscopic Resection ◽  
Barrett's Esophagus ◽  
Recurrent Disease ◽  
Low Grade ◽  
Sustained Remission ◽  
Efficacy And Safety ◽  
Efficient Treatment

Abstract Background Radiofrequency ablation (RFA), combined with endoscopic resection, can be used as a primary treatment for low grade dysplasia, high grade dysplasia, and early esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE). The aim of the Belgian RFA registry is to capture the real-life outcome of endoscopic therapy for BE with RFA and to assess efficacy and safety outside study protocols, in the absence of reimbursement. Patients and methods Between February 2008 and January 2017, data from 7 different expert centers were prospectively collected in the registry. Efficacy outcomes included complete remission of intestinal metaplasia (CR-IM), complete remission of dysplasia (CR-D), and durability of remission. Safety outcomes included immediate and late adverse events. Results 684 RFA procedures in 342 different patients were registered. Of these, 295 patients were included in the efficacy analysis, with CR-IM achieved in 88 % and CR-D in 93 %, in per-protocol analysis; corresponding rates in intention-to-treat analysis were 82 % and 87 %, respectively. Sustained remission was seen in 65 % with a median (interquartile range) follow-up of 25 (12 – 47) months. No risk factors for recurrent disease were identified. Immediate complications occurred in 4 % of all procedures and 6 % of all patients, whereas late complications occurred in 9 % of all procedures and in 20 % of all patients. Conclusions Data from the Belgian registry confirm that RFA in combination with endoscopic resection is an efficient treatment for BE with dysplasia or early EAC. In the absence of reimbursement, more rescue treatments are used, not compromising outcome. Since there is recurrent disease after CR-IM in 35 %, surveillance endoscopy remains necessary.

scholarly journals Impact of the development of an endoscopic eradication program for Barrett’s esophagus with high grade dysplasia or early adenocarcinoma on the frequency of surgery

2018 ◽  
Vol 06 (09) ◽  
pp. E1085-E1092
Author(s):  
Prianka Chilukuri ◽  
Mark A. Gromski ◽  
Cynthia S. Johnson ◽  
Duy Khanh P. Ceppa ◽  
Kenneth A. Kesler ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Eradication Therapy ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Multivariable Logistic Regression ◽  
Early Adenocarcinoma ◽  
The Impact ◽  
Over Time

Abstract Background and aims The impact of the advent of an institutional endoscopic eradication therapy (EET) program on surgical practice for Barrett’s esophagus (BE)-associated high grade dysplasia (HGD) or suspected T1a esophageal adenocarcinoma (EAC) is unknown. The aims of this study are to evaluate the different endoscopic modalities used during development of our EET program and factors associated with the use of EET or surgery for these patients after its development. Methods Patients who underwent primary endoscopic or surgical treatment for BE-HGD or early EAC at our hospital between January 1992 and December 2014 were retrospectively identified. They were categorized by their initial modality of treatment during the first year, and the impact over time for choice of therapy was assessed by multivariable logistic regression. Results We identified 386 patients and 80 patients who underwent EET and surgery, respectively. EET included single modality therapy in 254 (66 %) patients and multimodal therapy in 132 (34 %) patients. Multivariable logistic regression showed that, for each subsequent study year, EET was more likely to be performed in patients who were older (P = 0.0009), with shorter BE lengths (P < 0.0001), and with a pretreatment diagnosis of HGD (P = 0.0054) compared to surgical patients. The diagnosis of EAC did not increase the utilization of EET compared to surgery as time progressed (P = 0.8165). Conclusion The introduction of an EET program at our hospital increased the odds of utilizing EET versus surgery over time for initial treatment of patients who were older, had shorter BE lengths or the diagnosis of BE-HGD, but not in patients with EAC.

scholarly journals Epidemiological Review of Gastroesophageal Junction Adenocarcinoma in Asian Countries

Digestion ◽  
2021 ◽  
pp. 1-8
Author(s):  
Noriaki Manabe ◽  
Kazuhiro Matsueda ◽  
Ken Haruma
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Gastroesophageal Junction ◽  
Eradication Therapy ◽  
Carcinogenic Risk ◽  
Asian Countries ◽  
Western Countries ◽  
Gastroesophageal Junction Adenocarcinoma ◽  
H Pylori ◽  
Epidemiological Trends

<b><i>Background:</i></b> Similar trends in the prevalence of gastroesophageal reflux disease (GERD), obesity, and <i>Helicobacter pylori</i> infection have been observed in Asian and Western countries despite their time differences. However, it is unclear whether the prevalence of gastroesophageal junction adenocarcinomas in Asian countries is increasing. In this review, we discuss the epidemiological trends of gastroesophageal junction adenocarcinoma in Asian countries. <b><i>Summary:</i></b> The prevalence of GERD is increasing in Asian countries, but most cases are considered mild. Obesity is a serious problem worldwide, but it is considered less serious in Asia than in Western countries. In Asian countries where gastric cancer is common, both cardiac and noncardiac cancers are associated with high rates of <i>H. pylori</i> infection, which is considered a carcinogenic risk factor for both sites of cancer. The widespread use of <i>H. pylori</i> eradication therapy for chronic gastritis in several Asian countries has not directly led to an increased prevalence of esophageal adenocarcinoma. One of the originating sites of junctional adenocarcinoma in most Asian countries is Barrett’s esophagus, with short-segment Barrett’s esophagus having much lower carcinogenicity than long-segment Barrett’s esophagus. <b><i>Key Messages:</i></b> Considering the future trends of several risk factors for gastroesophageal junction adenocarcinoma in Asian countries, it is likely that the incidence of gastroesophageal junction adenocarcinoma will gradually increase, but not at a rate that exceeds that of squamous cell carcinoma, as in Western countries.

Circumferential endoscopic resection of Barrett’s esophagus with high-grade dysplasia or early adenocarcinoma

2007 ◽  
Vol 21 (5) ◽  
pp. 820-824 ◽  
Author(s):  
C. V. Lopes ◽  
M. Hela ◽  
C. Pesenti ◽  
E. Bories ◽  
F. Caillol ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Endoscopic Resection ◽  
Barrett's Esophagus ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Early Adenocarcinoma
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