ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging–assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus

Thosani, Nirav; Dayyeh, Barham K. Abu; Sharma, Prateek; Aslanian, Harry R.; Enestvedt, Brintha K.; Komanduri, Sri; Manfredi, Michael A.; Navaneethan, Udayakumar; Maple, John T.; Pannala, Rahul; Parsi, Mansour A.; Smith, Zachary L.; Sullivan, Shelby; Banerjee, Subhas

doi:10.1016/j.gie.2016.01.007

Cited by 182 publications

(144 citation statements)

References 56 publications

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“…Current guidelines recommend endoscopic surveillance in BE, with random 4-quadrant biopsy specimens obtained every 1–2 cm to detect dysplasia (Seattle protocol), in addition to targeted biopsies of suspicious lesions under WLE [22]. Concerning the ability of AEITs to detect dysplasia in BE, two studies showed that NBI with targeted biopsies improves the diagnosis of dysplasia when compared to HDWL examination with the Seattle protocol [9, 23].…”

Section: Esophagusmentioning

confidence: 99%

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Barbeiro

Libânio

Castro

et al. 2018

GE Port J Gastroenterol

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Narrow-band imaging is an advanced imaging system that applies optic digital methods to enhance endoscopic images and improves visualization of the mucosal surface architecture and microvascular pattern. Narrow-band imaging use has been suggested to be an important adjunctive tool to white-light endoscopy to improve the detection of lesions in the digestive tract. Importantly, it also allows the distinction between benign and malignant lesions, targeting biopsies, prediction of the risk of invasive cancer, delimitation of resection margins, and identification of residual neoplasia in a scar. Thus, in expert hands it is a useful tool that enables the physician to decide on the best treatment (endoscopic or surgical) and management. Current evidence suggests that it should be used routinely for patients at increased risk for digestive neoplastic lesions and could become the standard of care in the near future, at least in referral centers. However, adequate training programs to promote the implementation of narrow-band imaging in daily clinical practice are needed. In this review, we summarize the current scientific evidence on the clinical usefulness of narrow-band imaging in the diagnosis and characterization of digestive tract lesions/cancers and describe the available classification systems.

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Section: Esophagusmentioning

confidence: 99%

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Barbeiro

Libânio

Castro

et al. 2018

GE Port J Gastroenterol

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“…Additionally, the specificity should be sufficiently high (≥80%) to allow for a decrease in the number of biopsies (compared with random biopsies). In 2016, a systematic review and meta-analysis was conducted by the ASGE technology committee and reported that acetic acid chromoendoscopy, NBI, and endoscope-based confocal laser endomicroscopy (eCLE) met the proposed PIVI thresholds ( Table 1) (28).…”

Section: Advanced Imagingmentioning

confidence: 99%

“…Acetic acid is a colorless agent that reacts with and enhances the mucosal surface pattern, and has been shown to accurately distinguish between normal esophagus, BE, and neoplasia. In the ASGE technology group meta-analysis, a subgroup analysis of studies focusing on acetic acid chromoendoscopy demonstrated an overall sensitivity, NPV, and specificity of 96.6%, 98.3%, and 84.6%, respectively for detecting HGD/ EAC (28). Despite its documented usefulness, particularly with acetic acid, dye-based chromoendoscopy has not gained widespread clinical use, mainly due to the perception that it is tedious, inhomogeneous, and time-consuming, as well as lack of separate reimbursement.…”

Section: Advanced Imagingmentioning

confidence: 99%

“…NBI ( Figure 1) is generally the most widely available system, and subsequently the one most studied. NBI was shown to have >90% sensitivity and specificity for the detection of high grade dysplasia or EAC in two meta-analyses (28,32).…”

Section: Advanced Imagingmentioning

confidence: 99%

“…In a multi-center, international, randomized controlled trial published in 2014, it was shown that eCLE was able to significantly increase the diagnostic yield for HGD and EAC compared to the current standard of care (high definition white light endoscopy with random fourquadrant biopsies) (33). In a meta-analysis of five clinical trials, CLE had a pooled sensitivity of 90.4%, specificity of 89.9%, and a NPV of 96.2% for detecting HGD/EAC (28). The high costs associated with CLE and the requirement for administration of an intravenous fluorescent agent have limited widespread adoption.…”

Section: Advanced Imagingmentioning

confidence: 99%

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Barrett’s esophagus: best practices for treatment and post-treatment surveillance

Mansour

El–Serag

Anandasabapathy

2017

Ann. Cardiothorac. Surg.

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Barrett's esophagus (BE) is a premalignant condition that increases the risk of esophageal adenocarcinoma (EAC). Significantly more common in the Western world, risk factors include increased age, male sex, white race, gastro-esophageal reflux disease (GERD), central obesity, and cigarette smoking. The rates of progression to cancer depend on the grade of Barrett's dysplasia. Screening for BE is recommended in patients with GERD and additional risk factors. Endoscopic surveillance of patients with BE likely improves overall outcomes. Advanced endoscopic imaging can help increase the efficiency of current endoscopic surveillance.Endoscopic therapy is safe and effective for the treatment of dysplastic BE and intramucosal EAC, but ongoing surveillance following treatment is necessary. This review will cover screening, surveillance, advanced imaging, chemoprevention, endoscopic treatment, and post-treatment surveillance of BE.

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Barrett Esophagus

Sharma

2022

JAMA

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ImportanceBarrett esophagus is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia and affects approximately 5% of people in the US and approximately 1% worldwide. Approximately 3% to 5% of patients with Barrett esophagus will be diagnosed with esophageal adenocarcinoma in their lifetime.ObservationsBarrett esophagus affects approximately 2.3% to 8.3% of people with gastroesophageal reflux disease (GERD) and approximately 1.2% to 5.6% of people without GERD. Characteristics associated with Barrett esophagus include older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger), male sex, and smoking (prevalence of approximately 12% in people who smoke cigarettes compared with 1.1% in those who do not smoke cigarettes). The histopathology of Barrett esophagus progresses from metaplasia to dysplasia and, without treatment, can progress to adenocarcinoma. People with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing esophageal adenocarcinoma. Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years. In patients with Barrett esophagus and dysplasia or early cancer, endoscopic therapy consisting of resection and ablation successfully treats 80% to 90% of patients.Conclusions and RelevanceBarrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide and is associated with an increased risk of esophageal adenocarcinoma. First-line therapy for Barrett esophagus consists of proton-pump inhibitors for control of reflux symptoms, but their role in chemoprevention is unclear. Surveillance with upper endoscopy is recommended by practice guidelines to monitor for progression to esophageal adenocarcinoma, but randomized clinical trials are lacking.

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ASGE Technology Committee systematic review and meta-analysis assessing the ASGE Preservation and Incorporation of Valuable Endoscopic Innovations thresholds for adopting real-time imaging–assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus

Cited by 182 publications

References 56 publications

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

Barrett Esophagus

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