Intraepithelial High-Grade Neoplasia and Early Adenocarcinoma in Short-Segment Barrett’s Esophagus (SSBE): Curative Treatment Using Local Endoscopic Treatment Techniques

May, Andrea; Goßner, Liebwin; Pech, Oliver; Müller, Henning; Vieth, Michael; Stolte, Manfred; Ell, Christian

doi:10.1055/s-2002-33236

Cited by 153 publications

(80 citation statements)

References 17 publications

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“…In a follow-up study of a total of 115 patients (EMR = 70, PDT = 32, APC = 3, EMR + PDT = 10) undergoing endoscopic treatment for HGD or EC, there was a 31% rate of metachronous or recurrent lesions over an average follow-up time of 34 ± 10 mo. Individually, the metachronous or recurrence rate was 30% (21/70) in the EMR group vs 37.5% in the EMR + PDT group [70] . It is important to note that the number of patients treated with the combined modality is markedly less than that treated with EMR alone.…”

Section: High-grade Dysplasia and Early Adenocarcinoma In Barrett's Ementioning

confidence: 91%

“…In fact, a recently-published multicenter, randomized controlled trial has shown that photodynamic therapy with Photofrin is superior than omeprazole alone in eliminating HGD at 5 years follow-up (77% vs 39%, respectively) [69] . To improve eradication of neoplastic tissue and decrease recurrence rates, the combined use of EMR with ablative techniques have been described [59,70] . Theoretically, recurrence rates are expected to be much lower with combined modalities, because both visible and non-visible lesions would be eradicated.…”

Section: High-grade Dysplasia and Early Adenocarcinoma In Barrett's Ementioning

confidence: 99%

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Endoscopic mucosal resection in the upper gastrointestinal tract

Ahmadi¹,

Draganov²

2008

WJG

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Endoscopic mucosal resection (EMR) is a technique used to locally excise lesions confined to the mucosa. Its main role is the treatment of advanced dysplasia and early gastrointestinal cancers. EMR was originally described as a therapy for early gastric cancer. Recently its use has expanded as a therapeutic option for ampullary masses, colorectal cancer, and large colorectal polyps. In the Western world, the predominant indication for EMR in the upper gastrointestinal tract is the staging and treatment of advance dysplasia and early neoplasia in Barrett's esophagus. This review will describe the basis, indications, techniques, and complications of EMR, and its role in the management of Barrett's esophagus.

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Section: High-grade Dysplasia and Early Adenocarcinoma In Barrett's Ementioning

confidence: 91%

Section: High-grade Dysplasia and Early Adenocarcinoma In Barrett's Ementioning

confidence: 99%

Endoscopic mucosal resection in the upper gastrointestinal tract

Ahmadi¹,

Draganov²

2008

WJG

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“…EMR can be performed focally for staging endoscopically visible lesions that are suspicious for malignancy, but focal resection has been associated with a high rate of synchronous, metachronous and recurrent lesions in the residual Barrett's mucosa, which can reach to more than 30 % after a follow-up period of 3 years (92,111,(114)(115)(116). Therefore, once that all areas of localized neoplasia have been removed and appropriately staged, the remainder of the Barrett epithelium, in which there is a well established presence of molecular abnormalities, should be eradicated (5,117).…”

Section: Endoscopic Mucosal Resection (Emr)mentioning

confidence: 99%

Endoscopic diagnosis and therapies for Barrett esophagus: a review

Waxman

González-Haba-Ruiz

Vázquez-Sequeiros

2014

Rev. esp. enferm. dig.

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“…In this capacity and either alone or in conjunction with other ablative techniques results appear quite favorable. 11,12,[39][40][41][42] Reports of extended resection of flat mucosa have been published; however, it is likely that such extensive therapy will require considerable expertise and not be routinely available in clinical practice.…”

Section: Therapy For Barrett's Esophagusmentioning

confidence: 99%

Surveillance in Barrett's Esophagus: A Failed Premise

Inadomi

2009

Keio J. Med.

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Background: It is recommended that patients in whom Barrett's esophagus is diagnosed undergo surveillance endoscopy. However, multiple issues regarding the efficacy and feasibility of surveillance remain. Methods: Quantitative techniques were used to examine surveillance in patients with Barrett's esophagus. A retrospective case-control study was performed to determine whether surveillance endoscopy prolonged survival in a cohort of U.S. veterans diagnosed with esophageal adenocarcinoma. Cost-effectiveness analysis was employed to compare competing strategies of management for patients with Barrett's esophagus to determine whether surveillance strategies using alternative biomarkers could out-perform dysplasia based surveillance, and whether new techniques for eradicating Barrett's metaplasia would constitute cost-effective strategies. Results: Surveillance did not improve long-term survival among veterans diagnosed with esophageal adenocarcinoma. Lead-time bias has confounded previous reports claiming the efficacy of endoscopic surveillance. Cost-effectiveness analysis revealed that while screening 50-year old Caucasian males with heartburn may be cost-effective, surveillance even at 5 year intervals among patients with Barrett's esophagus without dysplasia exceeded the threshold of cost-effective care. If a biomarker were developed whose sensitivity and specificity to predict cancer development exceeded 80%, this could represent a more viable strategy than dysplasia-based surveillance and overcome the inherent inter-and intra-observer variations in dysplasia diagnosis that currently limit the effectiveness of surveillance programs. Finally, techniques that reduce cancer incidence such as endoscopic mucosal resection or ablation will likely be more cost-effective than current surveillance strategies that rely on early detection of cancer. Conclusions : Current recommendations for the management of patients with Barrett's esophagus are flawed. Future guidelines should include alternative markers of cancer risk and focus on strategies that reduce cancer incidence instead of cancer detection. (Keio J Med 58 (1) : 12

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Intraepithelial High-Grade Neoplasia and Early Adenocarcinoma in Short-Segment Barrett’s Esophagus (SSBE): Curative Treatment Using Local Endoscopic Treatment Techniques

Cited by 153 publications

References 17 publications

Endoscopic mucosal resection in the upper gastrointestinal tract

Endoscopic mucosal resection in the upper gastrointestinal tract

Endoscopic diagnosis and therapies for Barrett esophagus: a review

Surveillance in Barrett's Esophagus: A Failed Premise

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