Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: A systematic review

Dulai, Gareth S.; Guha, Sushovan; Kahn, Katherine L.; Gornbein, Jeffrey; Weinstein, Wilfred M.

doi:10.1053/gast.2002.30297

Cited by 313 publications

(167 citation statements)

References 46 publications

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“…Th e available evidence to support this hypothesis, however, consists of retrospective studies that may be subject to biases. Indeed, >90% of EACs are diagnosed in patients without a prior BE diagnosis, despite the increasing use of endoscopy ( 67,68 ). Given the number of patients involved, a widely embraced population screening eff ort could lead to substantial economic costs (from diagnostic tests and need for subsequent surveillance).…”

Section: Summary Of Evidencementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,317

1,387

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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: Summary Of Evidencementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,317

1,387

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“…For patients with BE, endoscopic surveillance is used in an effort to reduce mortality through early detection of progression to ADC. However, only about 5% of ADC arise in patients with previously diagnosed BE 10 and the procedure is expensive and invasive. Understanding the molecular mechanisms underlying the development of BE and progression to ADC is key to the rational design of novel strategies for early detection and therapeutic intervention.…”

mentioning

confidence: 99%

Gene expression profiling of esophageal cancer: Comparative analysis of Barrett's esophagus, adenocarcinoma, and squamous cell carcinoma

Greenawalt¹,

Duong²,

Smyth³

et al. 2007

Intl Journal of Cancer

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Esophageal cancer is a particularly aggressive tumor with poor prognosis, however, our current knowledge of the genes and pathways involved in tumorigenesis of the esophagus are limited. To obtain insight into the molecular processes underlying tumorigenesis of the esophagus, we have used cDNA microarrays to compare the gene expression profiles of 128 tissue samples representing the major histological subtypes of esophageal cancer (squamous cell carcinoma and adenocarcinoma (ADC)) as well as Barrett's esophagus (BE), the precursor lesion to ADC, and normal esophageal epithelium. Linear discriminant analysis and unsupervised hierarchical clustering show the separation of samples into 4 distinct groups consistent with their histological subtype. Differentially expressed genes were identified between each of the tissue types. Comparison of gene ontologies and gene expression profiles identified gene profiles specific to esophageal cancer, as well as BE. “Esophageal cancer clusters,” representing proliferation, immune response, and extracellular matrix genes were identified, as well as digestion, hydrolase, and transcription factor clusters specific to the columnar phenotype observed during BE and esophageal ADC. These clusters provide valuable insight into the molecular and functional differences between normal esophageal epithelium, BE, and the 2 histologically distinct forms of esophageal cancers. Our thorough, unbiased analysis provides a rich source of data for further studies into the molecular basis of tumorigenesis of the esophagus, as well as identification of potential biomarkers for early detection of progression. © 2007 Wiley‐Liss, Inc.

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“…In fact, the real problems in the management of Barrett's esophagus continue to be twofold: (1) identification of patients at risk for development of adenocarcinoma in the absence of mucosal abnormalities or histologic dysplasia; and (2) only the minority of patients with esophageal adenocarcinoma have undergone prior endoscopy [24]. Is the fact that many gastroenterologists do not perform rigorous surveillance as recommended by practice guidelines a reason to default to the position of ablation of Barrett's esophagus?…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

Falk

2010

Dig Dis Sci

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Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: A systematic review

Cited by 313 publications

References 46 publications

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

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

Gene expression profiling of esophageal cancer: Comparative analysis of Barrett's esophagus, adenocarcinoma, and squamous cell carcinoma

Radiofrequency Ablation of Barrett’s Esophagus: Let’s Not Get Ahead of Ourselves

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