Normalization of Intestinal Metaplasia in the Esophagus and Esophagogastric Junction: Incidence and Clinical Data

Horwhat, John D.; Baroni, Darren; Maydonovitch, Corinne; Osgard, Eric M.; Ormseth, Eric M.; Rueda-Pedraza, Eugenia; Lee, Hyun Jae; Hirota, William K.; Wong, Roy K.H.

doi:10.1111/j.1572-0241.2006.00994.x

Cited by 48 publications

(35 citation statements)

References 63 publications

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“…These data appear to support the previous contention that patients with longer BE are at higher risk of developing EAC [80]. Horwhat et al [18] also showed that the incidence density for EAC/dysplasia in an LSBE cohort was 7.7 % pyrs, whereas the incidence density of dysplasia was 1.8 % pyrs in the SSBE cohort. In contrast, another meta-analysis by Yousef et al [64] found no difference in the pooled estimate of overall cancer incidence between patients with LSBE (0.67 % pyrs) and those with SSBE (0.61 % pyrs).…”

Section: Be Length and Carcinogenesissupporting

confidence: 79%

“…There are a few reports from the West in which the lower end of the palisade vessels is used as the landmark for the EGJ as in Japan [17][18][19]. An important disadvantage of considering the proximal ends of the gastric folds as the landmark for the EGJ is that the diagnostic concordance is very low, especially in ultra-short (\1 cm in length) and short-segment BE (SSBE), in which is difficult to detect this landmark.…”

Section: Argument Regarding Landmark Of Esophagogastric Junction In Tmentioning

confidence: 99%

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Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Watari

Oshima

Fukui

et al. 2013

Clin J Gastroenterol

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Barrett's esophagus (BE) is a premalignant condition of esophageal adenocarcinoma (EAC). Although the incidence of BE has risen rapidly in the West, it is rare in Asia despite a recent increase in the prevalence of gastroesophageal reflux disease. Controversies over the definition of BE are presented because most cases show shortsegment BE, especially ultra-short BE, in Asia. Here we review possible risk factors for the development of EAC, particularly possible roles of ethnicity, specialized intestinal metaplasia (SIM), BE length, and environmental factors, such as Helicobacter pylori infection and obesity. Additionally, we summarize recent studies on the effect of chemoprevention including proton pump inhibitors, nonsteroidal anti-inflammatory drugs or aspirin in order to reduce the risk of neoplastic progression in BE patients. Although substantial knowledge of risk factors of dysplasia/EAC in BE is shown, the risk for neoplastic development may be influenced by geographic variation, study population, the presence or absence of SIM or dysplasia at baseline, and the small number of BE patients investigated. Recently, the efficiency of surveillance for BE patients has been discussed from the standpoint of cost-effectiveness. It may be too difficult to draw conclusions because no randomized clinical trials of BE surveillance have been performed.

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Section: Be Length and Carcinogenesissupporting

confidence: 79%

Section: Argument Regarding Landmark Of Esophagogastric Junction In Tmentioning

confidence: 99%

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Watari

Oshima

Fukui

et al. 2013

Clin J Gastroenterol

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“…These include high-dose proton pump inhibition with surveillance, photodynamic therapy, argon-beam coagulation, laser ablation, multipolar electrocoagulation, endoscopic mucosal resection, and cryotherapy. Medical therapy with maximal acid suppression has generally shown poor rates of Barrett's metaplasia regression, and an optimal protocol for surveillance is yet to be fully validated [17][18][19]. Issues with respect to these techniques have centered around incomplete ablation, especially this issue of ''buried glands'' (i.e., Barrett's metaplasia persistent under of layer of normal squamous epithelium) [8][9][10][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

Velanovich

2009

Surg Endosc

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“…Endoscopically, this is accepted as the most proximal level of gastric folds whereas the squamocolumnar junction is the border between esophageal squamous mucosa and gastric columnar mucosa. Specialized intestinal metaplasia in the short segment of Barrett's esophagus (SSBE) has been reported to revert with medication, whereas the progression to carcinoma is signifi cantly high in long segments of Barrett's esophagus (LSBE) Duration of procedure is in minutes NG, not given; MBDB, methylene blue-directed biopsies; RB, random biopsies [32,33]. It has been suggested that the LSBE requires more frequent surveillance assessments.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus

Admad

Ahmed

2010

Esophagus

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A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett's esophagus Abstract This study was designed to examine the shortfalls of methylene blue-directed biopsies (MBDB) and conventional random biopsies (RB) in the surveillance of Barrett's esophagus. A Cochrane and Medline search was performed, and fi ve randomized controlled trials (RCTs) comprising 213 patients were selected for the meta-analysis. Random biopsies failed to spot specialized intestinal metaplasia (SIM) in a signifi cantly higher number of patients than MBDB (risk ratio, 0.724; confi dence interval, 0.552-0.950). The rate of underdiagnosis of dysplasia was comparable between the two techniques (risk ratio, 0.766; confi dence interval, 0.273-2.147). More biopsies were obtained using the RB technique, and a signifi cantly higher number of biopsies was reported as normal in comparison to MBDB (P = 0.014). The use of endoscopic staining was associated with prolongation of the procedure time (P = 0.009). It was concluded that SIM is overlooked more often in conventional biopsy techniques, but the incidence of undetected dysplasia is comparable using both methods. The routine use of methylene blue in the surveillance of Barrett's esophagus seems to be unnecessary.

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Normalization of Intestinal Metaplasia in the Esophagus and Esophagogastric Junction: Incidence and Clinical Data

Abstract: (a) Normalization of SIM occurs most frequently in EGJSIM>SSBE>LSBE. (b) Factors associated with normalization favor less severe GER and shorter segments of SIM. (c) Surveillance of LSBE results in the greatest yield for identifying dysplasia and cancer.

Cited by 48 publications

References 63 publications

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus: initial results and lessons learned

A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus

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