Directional distribution of neoplasia in Barrett's esophagus is not influenced by distance from the gastroesophageal junction

Cassani, Lisa S.; Sumner, Eric; Slaughter, James C.; Yachimski, Patrick

doi:10.1016/j.gie.2013.01.026

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…18 Early studies of dysplasia in esophagectomy specimens and a study of early neoplasia did not find a spatial predisposition, but given their sample sizes, had limited power to detect effects of the magnitude we report. 19-23 These studies suggested that areas of high-grade dysplasia were generally contiguous but could vary greatly in location and extent.…”

Section: Discussionmentioning

confidence: 99%

Spatial Predisposition of Dysplasia in Barrett’s Esophagus Segments: A Pooled Analysis of the SURF and AIM Dysplasia Trials

Cotton¹,

Duits

Wolf

et al. 2015

American Journal of Gastroenterology

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Introduction Surveillance endoscopy detects dysplasia within Barrett's esophagus (BE) and dictates treatment. Current biopsy regimens recommend uniformly-spaced random biopsies. We assessed the distribution of dysplasia in BE to develop evidence-based biopsy regimens. Methods We performed analysis of the distribution of dysplasia within BE, using pre-treatment biopsy data from two randomized controlled trials (RCT) of radiofrequency ablation (RFA) for dysplastic BE: the SURF Trial and the AIM Dysplasia Trial. We used generalized linear models with generalized estimating equations to estimate prevalence differences for dysplasia depending on the standardized location of biopsies. We performed Monte Carlo simulation of biopsy regimens to estimate their yield for any dysplasia within segments. Results Dysplasia preferentially resides in the proximal-most half of the BE segment, which is almost twice as likely to demonstrate dysplasia as the distal-most quartile. In pooled analysis, compared to the distal-most quarter, the prevalence difference in the proximal-most quarter was 22.6%, in the second proximal-most quarter 23.1%, and in the second distal-most quarter 15.3%. The best performing biopsy regimen in simulation studies acquired 8 biopsies in the most proximal centimeter of BE, 8 biopsies in the second cm, and 2 biopsies in each cm thereafter q1cm - (8, 8, 2, 2…). A slightly simpler q2cm regimen q2cm - (12, 12, 4…) was nearly as effective. Conclusion Post-hoc analysis of two RCTs reveals a substantially increased prevalence of dysplasia proximally in BE segments. Our simulations suggest an altered biopsy regimen could increase sensitivity of biopsies in short-segment BE by >30%.

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Section: Discussionmentioning

confidence: 99%

Spatial Predisposition of Dysplasia in Barrett’s Esophagus Segments: A Pooled Analysis of the SURF and AIM Dysplasia Trials

Cotton¹,

Duits

Wolf

et al. 2015

American Journal of Gastroenterology

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“…Recent studies have examined the location of dysplastic nodules within treatment-naïve segments of BE, but data describing the location of recurrent BE after radiofrequency ablation are scant. 7–9 Additionally, the endoscopic phenotype of recurrent BE is not well-described, and inference from the few studies that report the appearance of recurrence is limited by small samples of patients, populations with predominantly non-dysplastic BE before treatment, and/or the lack of description of endoscopic findings in patients under surveillance that do not experience recurrence. 10–12 Without data reporting endoscopic findings in patients that do not recur, it is difficult to empirically judge the diagnostic value of endoscopic findings.…”

Section: Introductionmentioning

confidence: 99%

Recurrent intestinal metaplasia after radiofrequency ablation for Barrett’s esophagus: endoscopic findings and anatomic location

Cotton¹,

Wolf²,

Pasricha³

et al. 2015

Gastrointestinal Endoscopy

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Background Radiofrequency ablation (RFA) is a safe and effective treatment for Barrett’s esophagus (BE) that results in high rates of complete eradication of intestinal metaplasia (CEIM). However, recurrence is common after CEIM and surveillance endoscopy is recommended. Neither the anatomic location nor the endoscopic appearance of these recurrences is well described. Objective The objectives of this study are to describe the location of histologic specimens positive for recurrence after CEIM and the testing performance of endoscopic findings for the histopathologic detection of recurrence. Design Retrospective cohort. Setting Single referral center. Patients 198 BE patients with at least 2 surveillance endoscopies after CEIM. Interventions RFA, endoscopic mucosal resection (EMR), surveillance endoscopy. Main outcome measurements The anatomic location and histologic grade of recurrence. Results In a mean 3.0 years of follow-up, 32 (16.2%; 95% CI, 11.0%–22.0%) patients recurred, 5 (2.5%; 95% CI, 0.3%–4.7%) of which progressed beyond their worst pre-treatment histology. Recurrence was most common at or near the gastroesophageal junction (GEJ). Recurrence greater than 1 cm proximal to the GE junction was always accompanied by endoscopic findings, and random biopsies in these areas detected no additional cases. The sensitivity of any esophageal sign under high-definition white-light or narrow-band imaging for recurrence was 59.4% [42.4%, 76.4%] and the specificity was 80.6% [77.2%, 84.0%]. Limitations Single-center study Conclusions Recurrent IM is often not visible to the endoscopist and is most common near the GEJ. Random biopsies >1 cm above the GEJ had no yield for recurrence. In addition to biopsy of prior EMR sites and of suspicious lesions, random biopsies oversampling the GEJ are recommended.

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“…19,20,21,22 Work from our group found that 85% of patients with adenocarcinoma/high-grade dysplasia referred for endoscopic management had these abnormalities located in the right hemisphere of the esophagus, predominantly in the area between 12 and 3 o’clock. 20 Similar findings were described in an Australian study, where over 50% of advanced lesions were found between 2 and 5 o’clock.…”

Section: Endoscopic Risk Factorsmentioning

confidence: 91%

Predictors of Progression to High-Grade Dysplasia or Adenocarcinoma in Barrett’s Esophagus

Whitson

Falk

2015

Gastroenterology Clinics of North America

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Article Synopsis The prevalence of esophageal adenocarcinoma is increasing dramatically. Barrett’s esophagus remains the most well established risk factor for the development of esophageal adenocarcinoma. There are multiple clinical, endoscopic, and pathologic factors that increase the risk of neoplastic progression to high-grade dysplasia or esophageal adenocarcinoma in Barrett’s esophagus. This article will review both risk and protective factors for neoplastic progression in patients with Barrett’s esophagus.

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Directional distribution of neoplasia in Barrett's esophagus is not influenced by distance from the gastroesophageal junction

Cited by 23 publications

References 21 publications

Spatial Predisposition of Dysplasia in Barrett’s Esophagus Segments: A Pooled Analysis of the SURF and AIM Dysplasia Trials

Spatial Predisposition of Dysplasia in Barrett’s Esophagus Segments: A Pooled Analysis of the SURF and AIM Dysplasia Trials

Recurrent intestinal metaplasia after radiofrequency ablation for Barrett’s esophagus: endoscopic findings and anatomic location

Predictors of Progression to High-Grade Dysplasia or Adenocarcinoma in Barrett’s Esophagus

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