Endoscopic therapy for Barrett's oesophagus

Blevins, Christopher H.; Iyer, Prasad G.

doi:10.1016/j.bpg.2014.11.007

Cited by 14 publications

(8 citation statements)

References 63 publications

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“…1,2 Several endoscopic modalities are used in isolation or in combination for endoscopic therapy of BE, such as EMR, radiofrequency ablation (RFA), photodynamic therapy (PDT), cryotherapy, argon plasma coagulation (APC), multipolar electrocoagulation, and laser therapy. 3 Endoscopic therapy with EMR followed by PDT or RFA has been shown to be effective in reducing the risk of progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). 4-6 …”

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confidence: 99%

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Krishnamoorthi

Singh

Ragunathan

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Previous estimates of incidence of intestinal metaplasia (IM) recurrence after achieving complete remission of IM (CRIM) through endoscopic therapy of Barrett's esophagus (BE) have varied widely. We performed a systematic review and meta-analysis of studies to estimate an accurate recurrence risk after CRIM. Methods We performed a systematic search of multiple literature databases through June 2015 to identify studies reporting long-term follow-up after achieving CRIM through endoscopic therapy. Pooled incidence rate (IR) of recurrent IM, dysplastic BE, and high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) per person-year of follow-up after CRIM was estimated. Factors associated with recurrence were also assessed. Results We identified 41 studies that reported 795 cases of recurrence in 4443 patients over 10,427 patient-years of follow-up. This included 21 radiofrequency ablation studies that reported 603 cases of IM recurrence in 3186 patients over 5741 patient-years of follow-up. Pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC after radiofrequency ablation were 9.5% (95% CI, 6.7-12.3), 2.0% (95% CI, 1.3-2.7), and 1.2% (95% CI, .8-1.6) per patient-year, respectively. When all endoscopic modalities were included, pooled IRs of recurrent IM, dysplastic BE, and HGD/EAC were 7.1% (95% CI, 5.6-8.6), 1.3% (95% CI, .8-1.7), and .8% (95% CI, .5-1.1) per patient-year, respectively. Substantial heterogeneity was noted. Increasing age and BE length were predictive of recurrence; 97% of recurrences were treated endoscopically. Conclusions The incidence of recurrence after achieving CRIM through endoscopic therapy was substantial. A small minority of recurrences were dysplastic BE and HGD/EAC. Hence, continued surveillance after CRIM is imperative. Additional studies with long-term follow-up are needed.

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confidence: 99%

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Krishnamoorthi

Singh

Ragunathan

et al. 2016

Gastrointestinal Endoscopy

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“…EMR has been reported as the first-line therapy for large colorectal lesions. ESD has gained acceptance to be associated with higher rates of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events 28 , 29 . While APC was directly applied to relatively bigger pedicellated and sessile polyps or adenoma in order to treat with the residue tissues after the first snare 30 .…”

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confidence: 99%

Critical Role of p53 and K-ras in the Diagnosis of Early Colorectal Cancer: a One-year, Single-center Analysis

et al. 2017

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Background: Colorectal cancer (CRC) is strongly associated with colorectal polyps, which has become the third most common cancer in China. In the present study, we revealed the susceptible population and risk factors of colorectal polyps, and analyzed the expression of Ki-67, p53 and K-ras in the intestinal mucosa of patients with colorectal polyps in order to explore their significance in the detection and prognosis of CRC at an early stage.Materials and Methods: Total 801 cases of colorectal polyps were collected during endoscopic resection including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Expression of Ki-67, p53 and K-ras in the intestinal mucosa was detected by immunohistochemistry and quantitative real-time polymerase chain reaction (qRT-PCR), respectively. Histological analysis was performed by Hematoxylin and eosin (HE) staining. Categorical variables were compared by one-way ANOVA, Pearson test, Spearman test, Kruskal-Wallis test and analysis of regression.Results: Of all patients with colorectal polyps, 90.76% of patients (n = 727) were ≥ 50 years old. 530 cases (66.17%) were males compared with 271 females (33.83%) in all 801 cases. More importantly, 1.03% patients (n = 7) underwent polypectomy and histological examination was confirmed to be the early stage of CRC. The expression of p53 was found to be significantly decreased, while K-ras was increased in tumor tissues of CRC compared with that in hyperplastic polyps and healthy controls.Conclusions: 1.03% patients (n = 7) underwent polypectomy was confirmed to be the early stage of CRC. Histological analysis for expression of p53 and K-ras can guarantee to screen the early stage of CRC.

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“…PDT plays no significant role any more due to its side effect of photosensitivity of the skin. Although there are no head to head comparative trials RFA seems to be superior and has become the preferred procedure for endoscopic ablation [ 40 , 41 ]. In a meta-analysis including more than 3800 patients RFA achieved complete eradication of dysplasia in 91% and complete eradication of intestinal metaplasia in 78% of patients.…”

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Barrett’s esophagus: lessons from recent clinical trials

Golger

Probst²,

Messmann³

2016

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Data from recent studies cast doubt on former recommendations on diagnosis and management of Barrett’s esophagus. Based on latest research findings several Gastroenterological Associations actualized their guidelines and international experts compiled consensus statements as practical help for clinicians. In this review we discuss recent trials and their impact on clinical practice, current recommendations and persisting controversies in Barrett’s esophagus.

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Endoscopic therapy for Barrett's oesophagus

Cited by 14 publications

References 63 publications

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Risk of recurrence of Barrett’s esophagus after successful endoscopic therapy

Critical Role of p53 and K-ras in the Diagnosis of Early Colorectal Cancer: a One-year, Single-center Analysis

Barrett’s esophagus: lessons from recent clinical trials

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