Low-Grade Dysplasia in Barrett's Esophagus: Overdiagnosed and Underestimated

Curvers, Wouter L.; Kate, Fiebo J. ten; Krishnadath, Kausilia K.; Visser, Mike; Elzer, Brenda; Baak, Lubertus C.; Böhmer, Clarisse J M; Mallant-Hent, Rosalie C.; Oijen, Arnout van; Naber, A.H.J.; Scholten, Pieter; Busch, Olivier R.; Blaauwgeers, Hans; Meijer, Gerrit A.; Bergman, Jacques J.G.H.M.

doi:10.1038/ajg.2010.171

Cited by 428 publications

(353 citation statements)

References 41 publications

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“…Th e importance of the confi rmation of the diagnosis of LGD comes from two recent studies from the Netherlands. Review by two GI pathologists, with extensive experience in the diagnosis of BE-related neoplasia, found that of 147 patients diag nosed with LGD in the community, 85% of the patients were downgraded to a diagnosis of no dysplasia ( 122 ). Further work by that group examined 293 additional patients with LGD diagnosed in the community who had biopsies reviewed by at least 2 GI pathologists and 73% of the cases were downgraded to indefinite for dysplasia or nondysplastic BE ( 123 ).…”

Section: Advanced Endoscopic Imaging Techniquesmentioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

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: Advanced Endoscopic Imaging Techniquesmentioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

1,412

View full text Add to dashboard Cite

show abstract

“…Moreover, there exists a discrepancy among pathologists interpreting tissue samples. In a study from the Netherlands of patients diagnosed with LGD, 85% were downgraded to nondysplastic Barrett's esophagus (NDBE) after review by two expert GI pathologists [4]. Interestingly, in another international study, European pathologists had a higher concordance rate of interpretation than their US counterparts, which underlines the varied standards, experience, and clinical practice [5].…”

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confidence: 99%

Shining a White Light on Barrett’s Esophagus: What Does the BING Classification Bring?

Peter

2017

Dig Dis Sci

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“…This chapter aims to review some of these elements as well as the prognostic value of biomarkers for progression from BE to EAC. The importance of fulfilling the promise that these biomarkers hold is underscored by the notable increase in the risk of progression to cancer from 0.5% per year in non-dysplastic BE, to 13% in the setting of low-grade dysplasia, and to 40% in high-grade dysplasia (Curvers et al, 2010;Wani et al, 2009). …”

Section: Introductionmentioning

confidence: 99%