Endoscopic surveillance of Barrett’s esophagus

Streitz, John M.; Andrews, Charles W.; Ellis, F. Henry

doi:10.1016/s0022-5223(19)34219-9

Cited by 257 publications

(60 citation statements)

References 13 publications

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“…[1][2][3][4][5] However, studies to date demonstrate considerable variability in physician adherence to consensus recommendations, particularly in the areas of screening and surveillance. [6][7][8][9][10][11][12] This variability has important implications in the care of BE patients, given the improved detection of dysplasia and early cancer with rigorous surveillance, [13][14][15] as well as the costs and risks associated with unnecessary tests and treatment. 16,17 Furthermore, little is known about physician attitudes toward newer technological advances in BE management, including advanced imaging technologies and endoscopic ablation therapies.…”

Section: Introductionmentioning

confidence: 99%

Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus

et al. 2014

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Considerable variability exists in adherence to practice guidelines for Barrett's esophagus (BE). Rapid advances in management approaches to BE led to a new American Gastroenterological Association (AGA) medical position statement in 2011. Our aim was to assess how well members of the AGA Clinical Practice section adhered to these guidelines. A self-administered survey incorporating questions on diagnostic criteria, cancer risk estimates, screening, surveillance, and therapeutics for BE was distributed electronically to 5850 North American members of the AGA Clinical Practice section. The response rate was 470 of 2040 opened e-mails (23%). Intestinal metaplasia was required for diagnosis of BE by 90%, but the Prague classification was used by only 53% of those aware of it. The annual risk of progression to esophageal adenocarcinoma was reported as 0.1-0.5% by 76%. Screening practices were variable, with 35% screening all patients with chronic gastroesophageal reflux disease and 15% repeating endoscopy in patients with gastroesophageal reflux disease following a negative screening. Surveillance guidelines were followed by 79% for nondysplastic BE and 86% for low-grade dysplasia, with expert pathology confirmation of dysplasia reported by 86%. Proton pump inhibitor dosing was variable, with 18% administering twice-daily doses and 30% titrating dose to symptoms. Ablation therapy was recommended by 6% for nondysplastic BE, 38% for low-grade dysplasia, and 52% for high-grade dysplasia. There is satisfactory adherence to the new AGA guidelines with respect to diagnosis, cancer risk estimates, and surveillance intervals in a select group of respondents. However, adherence continues to be variable in the use of the Prague classification, screening, and dosing of antisecretory therapy. Use of ablation therapy increases with grade of dysplasia. The reason for continued variability in adherence to BE practice guidelines remains unclear, and more evidence-based guidance is required to enhance clinical practice.

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Section: Introductionmentioning

confidence: 99%

Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus

et al. 2014

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“…The conclusion is that surveillance endoscopies should be carried out to allow early detection and treatment of esophageal adenocarcinoma in patients with Barrett's esophagus as shown by other authors. 9,43,44 Surgical treatment with Nissen fundoplication in patients with Barrett's esophagus allows significant reduction of acid exposure in the ultradistal esophagus, and multiple channel pH monitoring is an important technical procedure to evaluate and compare acid exposure in different levels of the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Use of multiple channel pH monitoring for evaluation of ultra-distal reflux in patients after fundoplication for treatment of Barrett's esophagus

Seguro

Santo

Szachnowicz

et al. 2011

Diseases of the Esophagus

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Dysplasia and esophageal adenocarcinoma may arise in patients with Barrett's esophagus after fundoplication esophageal pH monitoring showing no acid in esophagus. This suggests the need to develop methodology to evaluate the occurrence of ultra-distal reflux (1cm above the LES). The objective of the study was to compare acid exposition in three different levels: 5cm above the upper border of the LES, 1cm above the LES and in the intrasphincteric region. Eleven patients with Barrett's esophagus after Nissen fundoplication with no clinical, endoscopic and radiologic evidence of reflux were selected. Four-channel pH monitoring took place: channel A, 5cm above the upper border of the LES; channel B, 1cm above the LES; channel C, intrasphincteric; channel D, intragastric. The results of channels A, B and C were compared. There was significant increase in number of reflux episodes and a higher fraction of time with pH <4.0 in channel B compared to channel A. There was significant decrease in fraction of time with pH <4.0 in channel B compared to channel C. Two cases of esophageal adenocarcinoma were diagnosed in the studied patients. The region 1cm above the upper border of the LES is more exposed to acid than the region 5cm above the upper border of the LES, although this exposure occurred in reduced levels. The region 1cm above the upper border of the LES is less exposed to acid than the intrasphincteric region.

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“…It is now accepted that Barrett's esophagus is a premalignant condition. The enrollment of such patients in endoscopic surveillance programs has led to the detection of early adenocarcinomas (tumors confined to the mucosa or submucosa) and subsequent improved survival [48][49][50][51] (Fig. 6).…”

Section: Survival and Quality Of Life After Surgical Resectionmentioning

confidence: 99%

Surgical Management of Esophageal Carcinoma

Reed

1999

The Oncologist

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Surgical management of esophageal carcinoma is reviewed. The anatomy and biology are briefly mentioned, since these factors mitigate against the success of surgery. Staging, the key to proper treatment allocation and prognosis, is discussed, including the use of endoscopic ultrasonography, positron emission tomography, and thoracoscopy/laparoscopy. Patient selection and preparation for surgery are important considerations. Surgical techniques are then discussed, as are the advantages and disadvantages of various approaches, the morbidity of surgical resection, survival, and quality‐of‐life issues. Adjuvant treatment strategies (preoperative radiation, induction chemotherapy, induction chemoradiotherapy, and postoperative treatment) are summarized.

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Endoscopic surveillance of Barrett’s esophagus

Cited by 257 publications

References 13 publications

Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus

Adherence to the 2011 American Gastroenterological Association medical position statement for the diagnosis and management of Barrett's esophagus

Use of multiple channel pH monitoring for evaluation of ultra-distal reflux in patients after fundoplication for treatment of Barrett's esophagus

Surgical Management of Esophageal Carcinoma

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