Durability of Radiofrequency Ablation in Barrett's Esophagus With Dysplasia

Shaheen, Nicholas J.; Overholt, Bergein F.; Sampliner, Richard E.; Wolfsen, Herbert C.; Wang, Kenneth K.; Fleischer, David E.; Sharma, Virender K.; Eisen, Glenn M.; Fennerty, M. Brian; Hunter, John G.; Bronner, Mary P.; Goldblum, John R.; Bennett, Ana E.; Mashimo, Hiroshi; Rothstein, Richard I.; Gordon, Stuart R.; Edmundowicz, Steven A.; Madanick, Ryan D.; Peery, Anne F.; Muthusamy, V. Raman; Chang, Kenneth J.; Kimmey, Michael B.; Spechler, Stuart J.; Siddiqui, Ali A.; Souza, Rhonda F.; Infantolino, Anthony; Dumot, John A.; Falk, Gary W.; Galanko, Joseph A.; Jobe, Blair A.; Hawes, Robert H.; Hoffman, Brenda J.; Sharma, Prateek; Chak, Amitabh; Lightdale, Charles J.

doi:10.1053/j.gastro.2011.04.061

Cited by 415 publications

(304 citation statements)

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“…Data from cohort studies show that even among patients who underwent four sessions of radiofrequency ablation without complete eradication of IM (CEIM), >50% eventually attained this goal with subsequent therapy, suggesting that a concrete number cutoff for failure is not advisable ( 165 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,323

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,323

1,412

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“…-Complete eradication of dysplasia 92.6% - [28] -Residual dysplasia 7.4% - [28] -Natural history transition probabilities Full table available in reference - [26] Cost inputs RFA GB£1509 per session Average number of treatments = 3 [29,30] EMR GB£702 per session Average number of treatments = 1 [29,30] Stricture GB£3931 Average number of sessions to treat stricture is 1.3 (average) endoscopies and dilatations [19,[29][30] Perforation GB£7807 Cc score of 2-3. 6-day stay [30] Esophagectomy GB£9678 Excess bed days included.…”

Section: Effectiveness Inputsmentioning

confidence: 99%

“…Due to a lack of data, the majority of standard errors applied were assumptions. However, an approximation of the standard errors for the cost of EMR was derived from the interquartile ranges reported in NHS reference costs [30] and the α and β for the effectiveness inputs were derived from the trial [28].…”

Section: Sensitivity Analysismentioning

confidence: 99%

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

et al. 2017

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Aim:The aim was to evaluate the cost-effectiveness of endoscopic eradication therapy (EET) with combined endoscopic mucosal resection and radiofrequency ablation for the treatment of high-grade dysplasia (HGD) arising in patients with Barrett's esophagus compared with endoscopic surveillance alone in the UK. Materials & methods:The cost-effectiveness model consisted of a decision tree and modified Markov model. A lifetime time horizon was adopted with the perspective of the UK healthcare system. Results: The base case analysis estimates that EET for the treatment of HGD is cost-effective at a GB£20,000 cost-effectiveness threshold compared with providing surveillance alone for HGD patients (incremental cost-effectiveness ratio: GB£1272). Conclusion: EET is likely to be a cost-effective treatment strategy compared with surveillance alone in patients with HGD arising in Barrett's esophagus in the UK. Barrett's esophagus (BE) is a precancerous state that can develop into esophageal adenocarcinoma (OAC). BE exists in most patients in a metaplastic state and carries a very low risk of progression to invasive neoplasia and OAC in the region of 0.12-0.5% per year [1,2]. The 2013 British Society of Gastroenterology (BSG) guidelines advise that, in those patients with BE in whom there is no neoplasia, surveillance is recommended for those fit for endoscopy [3]. This is based on existing evidence from published studies which show that surveillance correlates with early-stage cancer diagnosis and likely improved survival from other cancers [4][5][6]. Recent work from the ProBar study group examined data from the Dutch cancer registry. They compared survival of patients with BE with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population. They found that OAC was diagnosed at an earlier stage during BE surveillance than in the general population. However, the survival of patients with BE with neoplastic progression was not significantly worse than those of patients without neoplastic progression, and was similar to survival of patients with stage 0 or stage 1 OAC in the general population [7]. In patients with OAC, the prognosis is poor with just over 15% patients being alive at 5 years [8].Current UK surveillance guidelines [3] recommend that patients with BE undergo endoscopy every 2-5 years. In some patients, no surveillance is recommended due to the negligible risk for cancer progression. The intervals are dependent on the length of BE and presence of intestinal metaplasia at the index endoscopy. However, in a minority of patients with BE there is a molecular and pathological transformation through various dysplastic stages to mucosal dysplasia and cancer and then finally invasive disease where it Cost-effectiveness analysis of endoscopic eradication therapy for treatment of highgrade dysplasia in Barrett's esophagus

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“…Several individual studies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)27) and 2 systematic reviews (that produced essentially identical results despite slightly different methodologies (16,17)) have reported that statin use, and particularly statin use combined with a cyclo-oxygenase inhibitor, is associated with a reduced incidence of esophageal adenocarcinoma. This has been reported in cohort studies and case-control studies of Barrett's patients and population-based studies compared to population-based controls, although not all studies are in agreement (28).…”

Section: Discussionmentioning

confidence: 99%

“…(3,4). It is accepted that metaplastic transformation of the esophageal squamous mucosa to intestinaltype mucosa (Barrett's esophagus (BE)) is a premalignant phenotype, although the overall rate of progression is relatively low (probably about 1 in 300 patients per year, or less) (5)(6)(7) and this has allowed the development of surveillance and localised treatment strategies such as radio-frequency ablation as means of preventing the development of EAC (8). However overall mortality from EAC remains considerable with 5-year survival less than 25% (9).…”

Section: Introductionmentioning

confidence: 99%