Properties of the Neosquamous Epithelium After Radiofrequency Ablation of Barrett's Esophagus Containing Neoplasia

Pouw, Roos E.; Gondrie, Joep J.; Rygiel, Agnieszka Magdalena; Sondermeijer, Carine; Kate, Fiebo J. ten; Odze, Robert D.; Vieth, Michael; Krishnadath, Kausilia K.; Bergman, Jacques J.G.H.M.

doi:10.1038/ajg.2009.88

Cited by 109 publications

(79 citation statements)

References 35 publications

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“…It is unclear whether biopsies with large capacity forceps will be more eff ective at sampling deeper layers of the neosquamous epithelium as compared with regular capacity biopsy forceps. Although neosquamous epithelium may be more permeable than normal squamous epithelium ( 185 ), it does not appear to harbor genetic abnormalities ( 186 ).…”

Section: Management Of Be After Endoscopic Therapymentioning

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: Management Of Be After Endoscopic Therapymentioning

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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“…Because of that, surgical resection should be reserved until the endoscopic treatment fails [3234] . RFA is effective transforming an esophagus with pathological cells into an esophagus with a normal mucosa, without genetic abnormalities that may become premalignant [43] . A recent systematic review [44] suggests that success rates are higher with RFA, with a sustained disappearance of the HGD in up to 90% of patients [20,23,35,43,45] .…”

Section: Hgd and Intramucosal Eamentioning

confidence: 99%

Update on management of Barrett's esophagus

Macias-García

Domínguez–Muñoz

2016

WJGPT

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develops as a consequence of gastroesophageal reflux disease. The significance of Barrett's metaplasia is that predisposes to cancer development. This article provides a current evidence-based review for the management of BE and related early neoplasia. Controversial issues that impact the management of patients with BE, including definition, screening, clinical aspects, diagnosis, surveillance, and management of dysplasia and early cancer have been assessed. Core tip: Barrett's esophagus (BE) is a common condition that predisposes to cancer development. This article provides a current evidence-based review for controversial issues that impact the management of patients with BE, including clinical aspects, diagnosis, surveillance, and management of dysplasia and early cancer. Macías-García INTRODUCTIONSince Barrett's esophagus (BE) was first described in 1950 [1] , the definition of this condition has been modified on several occasions. Presently, it is defined as the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer develop ment replaces the stratified squamous epithelium that normally lines the distal esophagus [2] . AbstractBarrett's esophagus (BE) is a common condition that MINIREVIEWSSubmit a

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“…Initial circumferential ablation is performed with a ballooncoupled bipolar electrode whereas secondary treatment for residual BE areas is performed with a bipolar electrode fitted to the endoscope's end. Recent data from clinical trials including patients with BE without dysplasia, with LGD or HGD, and with intramucosal ADC following EMR, demonstrate that RF ablation, combined or otherwise with EMR, is safe and effective for dysplasia and intestinal metaplasia eradication (113 under the new squamous epithelium (115,116). Similarly, RDF ablation preserves esophageal function without inducing stenosis.…”

Section: Radiofrequency (Rdf)mentioning

confidence: 99%