Ablating Barrett's metaplastic epithelium: are the techniques ready for clinical use?

Bergman, Jacques J.G.H.M.; Fockens, Paul

doi:10.1136/gut.2006.092106

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…Medical therapy with maximal acid suppression has generally shown poor rates of Barrett's metaplasia regression, and an optimal protocol for surveillance is yet to be fully validated [17][18][19]. Issues with respect to these techniques have centered around incomplete ablation, especially this issue of ''buried glands'' (i.e., Barrett's metaplasia persistent under of layer of normal squamous epithelium) [8][9][10][20][21][22]. The problem is that this buried metaplasia is capable of developing into carcinoma.…”

Section: Discussionmentioning

confidence: 98%

“…Therefore, until adenocarcinoma develops, only the mucosa needs to be addressed. However, previous attempts at mucosal ablation have been proven to be ineffective, primarily due to the issue of ''buried'' epithelium under normal appearing squamous epithelium, or have had unacceptably high complication rates, primarily structuring [8][9][10].…”

Section: Introductionmentioning

confidence: 98%

“…Results Sixty-six patients underwent Barrett's ablation. The median length of the Barrett's esophagus was 3 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] cm. Twelve patients (18%) had high-grade dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

Velanovich

2009

Surg Endosc

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

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Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

Velanovich

2009

Surg Endosc

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“…esophageal acid exposure time) during the 24 h esophageal pH monitoring increases progressively from endoscopy‐negative patients to those with worsening grades of esophagitis 2 . In vitro cell models of Barrett's esophagus indicate that short pulses of acid exposure increase cell proliferation 3 while intraesophageal acid suppression decreases it 4 . All these observations underscore the role of acid in the pathogenesis of GERD.…”

Section: Introductionmentioning

confidence: 93%

High‐dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia

Peng

Xiao

Chen

et al. 2012

J of Gastro and Hepatol

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“…Recent cost−effectiveness data in− deed suggest that complete eradication of non−neoplastic Bar− rett esophagus is more cost−effective than lifelong surveillance [22]. Despite these promising results, we believe that it is too early to broadly embrace RFA for treating patients with non−neo− plastic Barrett esophagus [23]. Compared with patients with BERN, patients with non−neoplastic Barrett esophagus have a lower rate of progression to adenocarcinoma (approximately 0.5 % per patient per year of follow−up).…”

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confidence: 99%

Total Barrett eradication: Is it ready for prime time?

Bergman

Sharma²

2008

Endoscopy

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Total Barrett Eradication review section 991This special issue of Endoscopy is dedicated to the subject of total Barrett eradication, that is the complete removal of Barrett esophagus and asso− ciated neoplasia by endoscopic resection and/or endoscopic ablation techniques. Many leading experts in the field have contributed to this im− portant issue. Drs. Shaheen and Spechler discuss the relevant methodological issues and pitfalls in studies of Barrett esophagus eradication [1], Drs. Curvers and Bansal offer recommendations for the endoscopic work−up of patients with Barrett esophagus−related neoplasia (BERN) [2], and Drs. Odze and Lauwers clearly describe how pre− and post−treatment histology should be evaluat− ed [3]. Subsequently, leaders in the field of thera− peutic endoscopy discuss the different available endoscopic treatment modalities for BERN: en− doscopic resection, argon plasma coagulation (APC), cryotherapy, photodynamic therapy (PDT), and radiofrequency ablation (RFA) [4 ± 7]. Finally, Drs. Peters [8] and Falk [9] look into the crystal ball to predict the future of endoscopic treatment of BERN from a surgeon's and an en− doscopist's viewpoint, respectively. Why has a special issue of Endoscopy been dedi− cated to this topic? The evidence is now accumu− lating that endoscopic treatment of BERN is safe and effective, suggesting that this approach should be preferred over esophagectomy in se− lected patients [10 ± 12]. New endoscopic tools, most recently endoscopic resection and RFA, ap− pear to be effective not only in removing BERN but also in completely eradicating all associated Barrett mucosa in the majority of treated patients [13 ± 16]. As a result, many expert centers have adopted advanced imaging, endoscopic resec− tion, and ablation as their management strategy for BERN. In our opinion, the past five years have yielded a number of very promising advances for our field in the endoscopic diagnosis, staging, and man− agement of BERN. We have moved from an era of "survey most lesions and operate on those with high grade dysplasia and cancer," to an era where we have the option to "survey all lesions, endoscopically treat selected lesions, and reserve surgery only for patients with invasive cancers involving the submucosa." We are witnessing a significant paradigm shift ± one that is accompa− nied by new challenges that we must be prepared to address. These challenges include: maintain− ing technical excellence and safety with all pro− cedures, via robust training programs; ensuring that visible lesions are detected and properly staged prior to initiation of an endoscopic treat− ment regimen; preparing the patient for endo− scopic management; evaluating the evidence cri− tically to determine ideal patient selection crite− ria, and which disease states should be treated; and evaluating the financial realities of cost−ef− fectiveness and reimbursement. Regarding technical excellence, endoscopic re− section and ablative therapies for BERN generally encompass multiple endoscopic modalities for diagnosi...

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Ablating Barrett's metaplastic epithelium: are the techniques ready for clinical use?

Cited by 8 publications

References 20 publications

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

High‐dose esomeprazole is required for intraesophageal acid control in gastroesophageal reflux disease patients with hiatus hernia

Total Barrett eradication: Is it ready for prime time?

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