Endoscopic surveillance of gastrointestinal premalignant lesions

Abstract

Purpose of the Review Provide an evidenced-based resource for the surveillance of gastrointestinal premalignant lesions, focusing on the scientific articles reported recently. Recent Findings No randomized controlled clinical trials exist to definitively support the efficacy of surveillance programs for Barrett’s esophagus and gastric intestinal metaplasia. However, surveillance of these premalignant lesions is recommended by some of the leading organizations. To optimize the usefulness of surveillance programs, targeting high-risk patients might maximize its benefits. A Barrett’s esophagus segment of ≥ 3cm and evidence of intestinal metaplasia can help stratify those patients at highest risk for progression to esophageal adenocarcinoma. The location, extent, and severity of intestinal metaplasia are indicators of risk of developing gastric cancer. Patients with extensive intestinal metaplasia should be offered endoscopic surveillance. Quality in the baseline colonoscopy is crucial, in order to decrease the risk of interval colorectal cancers. The importance of serrated polyps is emphasized as well as their surveillance intervals. Summary To optimize the usefulness of surveillance programs, targeting high-risk patients might maximize its benefits. Future research is needed to design more effective surveillance strategies. Recently emerging imaging techniques hold promise for improving sensitivity of endoscopic surveillance of premalignant conditions in the gastrointestinal track.

Global cancer statistics, 2012

“…In addition, a healthy diet rich in fruits and vegetables may lower a person's risk. Research is ongoing to determine whether surveillance of those with Barrett esophagus is a feasible method to reduce esophageal cancer mortality . Treating gastric reflux with proton pump inhibitor drugs or surgery may prevent Barrett esophagus and esophageal cancer, although once Barrett esophagus has developed, preventive measures have not been shown to prevent esophageal cancer .…”

“…Research is ongoing to determine whether surveillance of those with Barrett esophagus is a feasible method to reduce esophageal cancer mortality. 118,119 Treating gastric reflux with proton pump inhibitor drugs or surgery may prevent Barrett esophagus and esophageal cancer, although once Barrett esophagus has developed, preventive measures have not been shown to prevent esophageal cancer. 114 Further risk factor studies are necessary to elucidate primary prevention measures in high-risk areas (Northern Iran and Central Asia) because the prevalence of established major risk factors for esophageal cancer is low in those regions.…”

Targeted Optical Imaging Agents in Cancer: Focus on Clinical Applications

“…This thin layer of highly metabolic tissue can be thoroughly and rapidly evaluated in the clinic using methods of optical imaging. Many cancer surveillance guidelines recommend random biopsies, an approach that is inefficient, time consuming, and not widely practiced [ 12 – 18 ]. Targeted optical contrast agents have the potential to provide a molecular mechanism to complement the anatomical view of cancer provided by conventional imaging platforms.…”

Global Cancer Incidence and Mortality Rates and Trends—An Update

“…Studies are ongoing to determine how to prevent GERD and Barrett esophagus from progressing to esophageal cancer. Treating GERD with proton pump inhibitor drugs or surgery may prevent Barrett esophagus and cancer (88), and surveillance of those with Barrett esophagus may reduce esophageal cancer mortality (93,94).…”