Restoration of squamous mucosa after ablation of Barrett's esophageal epithelium

Berenson, Malcolm M.; Johnson, Timothy D.; Markowitz, Nathan R.; Buchi, Kenneth N.; Samowitz, Wade S.

doi:10.1016/0016-5085(93)90646-t

Cited by 230 publications

(87 citation statements)

References 21 publications

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“…The initial thermal coagulation devices were lasers that produced deep tissue injury. The feasibility of mucosal ablation was first demonstrated with these laser devices (42,44). Thermal ablation has subsequently been primarily done with either argon plasma coagulation or multipolar coagulation, which appear to have relatively similar effects based upon recent small randomized prospective trials (45,46).…”

Section: The Management Of Dysplasiamentioning

confidence: 99%

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Sampliner

2008

The American Journal of Gastroenterology

1,278

893

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PREAMBLEThe guidelines for the diagnosis, surveillance and therapy of Barrett's esophagus were originally published by the American College of Gastroenterology in 1998 and updated in 2002. These and other guidelines undergo periodic review. Significant advances have occurred in the area of Barrett's esophagus over the past four years leading to another revision of the prior guidelines. These advances include the potential use of esophageal capsule endoscopy for the diagnosis and screening of Barrett's esophagus, data regarding the outcome of low-grade dysplasia, the treatment of high-grade dysplasia using photodynamic therapy, and the development of new ablation techniques such as radiofrequency ablation. These guidelines are intended to be applied by physicians who see Barrett's esophagus patients and are intended to indicate a preferred, but certainly not the only, acceptable approach. Physicians need to choose the course best suited to the individual patient and to the variables that exist at the time of decision making. The guidelines are for adult patients with the diagnosis of Barrett's esophagus, as defined herein.Both these and the original guidelines were developed under auspices of the American College of Gastroenterology and the Practice Parameters Committee and approved by the Board of Trustees. The world literature was reviewed extensively for the original guidelines and once again reviewed using the National Library of Medicine database. Search terms used included Barrett's esophagus, esophageal neoplasm, esophagus, intestinal metaplasia, esophageal diseases, and adenocarcinoma, all appropriate studies and any additional ones found in reference to these papers were obtained and reviewed. Evidence was available from a hierarchy of trials and randomized controlled trials were given the greatest weight. Abstracts presented at national and international meetings were only used when unique data from ongoing trials were presented. When scientific data were lacking, recommendations are based on expert opinion. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), Grade B indicates that the evidence would be level 2 or 3 which are cohort studies or case control studies. Grade C recommendations are based on level 4 studies meaning case series or poor quality cohort studies, and Grade D recommendations are based on level 5 evidence meaning expert opinion.

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Section: The Management Of Dysplasiamentioning

confidence: 99%

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Sampliner

2008

The American Journal of Gastroenterology

1,278

893

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“…Regrowth of NSE is also seen in patients treated with various endoscopic ablative therapies, such as multipolar electrocoagulation, endoscopic mucosal resection, and photodynamic therapy in combination with antireflux therapy with proton pump inhibitors or surgery (13 -15). Previous studies examining NSE have found it to be histologically identical to normal squamous epithelium (9,12,16). However, with both proton pump inhibitor therapy as well as endoscopic ablation therapies, it is not uncommon to have a mosaic of both Barrett's specialized intestinal metaplasia and NSE in a patient's esophagus, and it is unclear whether squamous reepithelialization is associated with a reduction in cancer risk (15).…”

mentioning

confidence: 99%

Neosquamous Epithelium Does Not Typically Arise from Barrett's Epithelium

Paulson

Sanchez

et al. 2006

Clinical Cancer Research

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Purpose: Neosquamous epithelium (NSE) can arise within Barrett's esophagus as a consequence of medical or surgical acid reduction therapy, as well as after endoscopic ablation. Morphologic studies have suggested that NSE can develop from adjacent squamous epithelium, submucosal gland ducts, or multipotent progenitor cell(s) that can give rise to either squamous or Barrett's epithelium, depending on the luminal environment. The cells responsible for Barrett's epithelium self-renewal are frequently mutated during neoplastic progression. If NSE arises from the same cells that self-renew the Barrett's epithelium, the two tissues should be clonally related and share genetic alterations; if NSE does not originate in the self-renewing Barrett's, NSE and Barrett's esophagus should be genetically independent. Experimental Design: We isolated islands of NSE and the surrounding Barrett's epithelium from 20 patients by microdissection and evaluated each tissue for genetic alterations in exon 2 of CDKN2A or exons 5 to 9 of the TP53 gene. Nine patients had p16 mutations and 11 had TP53 mutations within the Barrett's epithelium. Results: In 1of 20 patients, a focus of NSE had a 146 bp deletion in p16 identical to that found in surrounding Barrett's epithelium. The NSE in the remaining 19 patients was wild-type for p16 or TP53. Conclusion: Our mutational data support the hypothesis that, in most circumstances, NSE originates in cells different from those responsible for self-renewal of Barrett's epithelium. However, in one case, NSE and Barrett's epithelium seem to have arisen from a progenitor cell that was capable of differentiating into either intestinal metaplasia or NSE.The stratified squamous epithelium that normally lines the esophagus is established in the 4th month of embryonic development (1) and usually persists until death. In some individuals, the squamous epithelium is replaced by a specialized intestinal metaplasia in response to chronic gastroesophageal reflux disease, a condition termed Barrett's esophagus (2). Patients with Barrett's esophagus are at a 30-to 40-fold increased risk for the development of esophageal adenocarcinoma, a cancer that has increased rapidly in incidence over the past 30 years (3). The mechanisms of conversion from squamous to intestinal epithelium are not known, but it has been hypothesized that the mucus-producing Barrett's specialized intestinal epithelium provides greater protection against the erosive effects of reflux than squamous epithelium (4).Treatment for Barrett's esophagus consists primarily of surgical and medical interventions to control gastroesophageal reflux. Proton pump inhibitors, used in the United States since the late 1980s, bind irreversibly to the H + /K + ATPase and prevent the production of acid by gastric parietal cells (5, 6). Proton pump inhibitors have become the treatment of choice for reflux and are remarkably effective, capable of reducing acid output by >95% (7). The development of effective acid suppression therapies has led to the observatio...

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“…All forms of ablation therapy including cryospray, radiofrequency ablation, argon plasma coagulation, photodynamic therapy, and laser therapy result in the destruction of the Barrett's mucosal layer with a replacement of newly developed squamous cells known as neosquamous epithelium [18]. A major clinical concern, however, with all forms of ablation has been residual or "buried" glands of Barrett's epithelium beneath the neosquamous epithelial layer [19].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

Sreenarasimhaiah¹

2014

J Gastroint Dig Syst

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Restoration of squamous mucosa after ablation of Barrett's esophageal epithelium

Cited by 230 publications

References 21 publications

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett's Esophagus

Neosquamous Epithelium Does Not Typically Arise from Barrett's Epithelium

Efficacy and Durability of Cryospray Ablation for Dysplastic Barrett’s Esophagus

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