M1938 The Significance of An Indefinite for Dysplasia Diagnosis in Patients with Barrett's Metaplasia

Younes, Mamoun; Lauwers, Gregory Y.; Ertan, Atilla; Verm, Ray; Meriano, Frank V.; McKechnie, John C.; Colman, Ronald; Lechago, Juan

doi:10.1016/s0016-5085(08)62031-4

Cited by 10 publications

(17 citation statements)

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“…More recent data suggest an especially high risk of progression to higher grades of dysplasia within the fi rst year of diagnosis but a risk comparable to nondysplastic BE aft er the fi rst year ( 126 ). Th e progression risk may be more pronounced in multifocal indefi nite for dysplasia (defi ned as indefi nite for dysplasia in biopsies from more than one level of the esophagus) than in focal indefi nite for dysplasia ( 127 ). Th us, surveillance in these patients should follow the recommendations for LGD as described below.…”

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

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“…A study looking at interobserver variability showed that the degree of agreement among pathologists for a diagnosis of indefinite for dysplasia is lower than that for LGD, with κ values of 0.18 and 0.35, respectively186 (Evidence grade III). Younes and coworkers showed that the rate of cancer progression in patients with indefinite for dysplasia was similar to non-dysplastic patients; however, if the indefinite for dysplasia was multifocal, the rate of progression was as high as in patients with LGD201 (Evidence grade III). An excess of inflammation is linked to cellular atypia, and this could be resolved by improved medical control of the gastro-oesophageal reflux, although scientific evidence for this is lacking (figure 4).…”

Section: Management Of Dysplasia and Early Cancermentioning

confidence: 99%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,170

1,297

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These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

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“…[36][37][38][39][40][41][42] Pathological diagnosis and staging To ensure accurate reporting of BE and dysplasia, it is recommended that in benign cases there is little uncertainty in diagnosis with the reliance on only 1 trained gastrointestinal pathologist. However, when any degree of dysplasia is suspected, at least 2 trained specialist gastrointestinal pathologists are needed to ascertain the severity of the lesion.…”

Section: 31mentioning

confidence: 99%