Health Benefits and Cost Effectiveness of Endoscopic and Nonendoscopic Cytosponge Screening for Barrett's Esophagus

Benaglia, Tatiana; Sharples, Linda D.; Fitzgerald, Rebecca C.; Lyratzopoulos, Georgios

doi:10.1053/j.gastro.2012.09.060

Cited by 148 publications

(126 citation statements)

References 38 publications

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“…Given its nonendoscopic nature, this device may allow cheaper, more convenient, offi ce-based screening for BE if validated in subsequent studies. Th is method has also been shown to be cost eff ective compared with no screening or sedated endoscopy in a modeling study ( 94 ).…”

Section: Surveillance Of Bementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

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: Surveillance Of Bementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

1,412

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“…Future alternatives might be screening of carefully selected absolute high-risk individuals (with a combination of risk factors) in combination with use of less invasive screening tools, e.g. Cytosponge or breath tests, 153,154 although more research is needed before these tools may be introduced in routine clinical practice.…”

Section: Outstanding Research Questions Detectionmentioning

confidence: 99%

Oesophageal cancer

et al. 2017

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SummaryOesophageal cancer is a clinically challenging disease requiring a multidisciplinary approach.The extensive treatment may be associated with serious limitations in health-related quality of life and yet still a poor prognosis. Recent decades have witnessed a gradual improvement in prognosis in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. There are several therapeutic alternatives for palliative treatment. This review aims to provide insights into the current clinical management, on-going controversies and future needs in oesophageal cancer.3

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“…28 A future paradigm is demonstrated in Fig 6, whereby symptomatic patients with heartburn would undergo Cytosponge™ assessment and, if found to contain Barrett's Although work has started to stratify patients according to clinical, histological and molecular risk, there is more work to be done. Factors, such as a patient's age or sex, body mass index or waist:hip ratio and drug intake, have all been implicated in Barrett's progression and, pending further studies, might have a part in deciding the need for surveillance.…”

Section: High-resoluɵon Endoscopy (Hre)mentioning

confidence: 99%

Targeting care in Barrett’s oesophagus

Zeki

Fitzgerald

2014

Clinical Medicine

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Barretts oesophagus represents the most signifi cant risk factor for the development of oesophageal adenocarcinoma (OAC), although the majority of patients will not develop cancer. However, early detection of OAC and its precursors signifi cantly improves outcome and underlines the importance of endoscopic surveillance programmes. Clearly there is a discrepancy between the small number of people who need to undergo surveillance because they are at signifi cant progression risk, and the large number that do. Research is therefore now concentrated on risk stratifi cation. Currently such stratifi cation is currently based on clinical fi ndings, endoscopic diagnosis and histopathological grade. Histopathology can be imperfect and is likely to require molecular confi rmation of different grades, thus molecular stratifi cation is becoming more important in this regard and p53 immunohistochemistry is already clinically useful, with other molecular biomarkers likely to prove benefi cial in the future. The hope is that non-endoscopic methods, such as the Cytosponge TM may be able to combine molecular biomarkers with histopathology and therefore perhaps benefi t a population screening as well as a surveillance programme.

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Health Benefits and Cost Effectiveness of Endoscopic and Nonendoscopic Cytosponge Screening for Barrett's Esophagus

Cited by 148 publications

References 38 publications

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

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

Oesophageal cancer

Targeting care in Barrett’s oesophagus

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