Surgical and endoscopic management of high grade dysplasia and early oesophageal adenocarcinoma

Page, Philip A. Le; Velu, Pras P.; Penman, Ian; Couper, Graeme; Paterson-Brown, Simon; Lamb, Peter

doi:10.1016/j.surge.2015.01.001

Cited by 16 publications

(7 citation statements)

References 19 publications

(19 reference statements)

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“…Of the manuscripts focusing on RFA, 1 was a randomized controlled trial, 19 cohort observational studies, and 5 case series. Two cohort studies were included in only the recurrent dysplasia analysis as they did not report how many patients had recurrent IM 40 41 . The distribution of studies based on geographic location was as follows: USA (23), Europe (13), Australia (2), and Canada (1).…”

Section: Resultsmentioning

confidence: 99%

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis

et al. 2017

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Background Conflicting data exist with regard to recurrence rates of intestinal metaplasia (IM) and dysplasia after achieving complete eradication of intestinal metaplasia (CE-IM) in Barrett’s esophagus (BE) patients. Aim (i) To determine the incidence of recurrent IM and dysplasia achieving CE-IM and (ii) to compare recurrence rates between treatment modalities [radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) vs stepwise complete EMR (SRER)]. Methods A systematic search was performed for studies reporting on outcomes and estimates of recurrence rates after achieving CE-IM. Pooled incidence [per 100-patient-years (PY)] and risk ratios with 95 %CI were obtained. Heterogeneity was measured using the I 2 statistic. Subgroup analyses, decided a priori, were performed to explore heterogeneity in results. Results A total of 39 studies were identified (25-RFA, 13-SRER, and 2 combined). The pooled incidence of any recurrence was 7.5 (95 %CI 6.1 – 9.0)/100 PY with a pooled incidence of IM recurrence rate of 4.8 (95 %CI 3.8 – 5.9)/100 PY, and dysplasia recurrence rate of 2.0 (95 %CI 1.5 – 2.5)/100 PY. Compared to the SRER group, the RFA group had significantly higher overall [8.6 (6.7 – 10.5)/100 PY vs. 5.1 (3.1 – 7)/100 PY, P = 0.01] and IM recurrence rates [5.8 (4.3 – 7.3)/100 PY vs. 3.1 (1.7 – 4)/100 PY, P < 0.01] with no difference in recurrence rates of dysplasia. Significant heterogeneity between studies was identified. The majority of recurrences were amenable to repeat endoscopic eradication therapy (EET). Conclusion The results of this study demonstrate that the incidence rates of overall, IM, and dysplasia recurrence rates post-EET are not inconsiderable and reinforce the importance of close surveillance after achieving CE-IM.

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Section: Resultsmentioning

confidence: 99%

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis

et al. 2017

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“…A total of 69 studies met the eligibility criteria and included 33 002 patients with OAC from 53 studies and 2712 with OGJAC from 28 studies. These studies were published from 1978 to 2019 and were conducted in US/Canada (n = 25, 36.2%), 7,17,18,20‐41 Europe (n = 30, 43.5%), 42‐71 Asia (n = 11, 15.9%), 72‐82 Africa (n = 1, 1.4%), 83 South America (n = 1, 1.4%) 84 or Australia (n = 1, 1.4%) 85 and included 55 single‐centre (79.7%), 7 multi‐centre (10.1%) and seven population‐based studies (10.1%) (Tables 1 and 2). OAC and OGJAC determination was made using surgical or endoscopic specimens (n = 59 studies), diagnosis codes (n = 3 studies) or cancer registry (n = 7 studies).…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: prevalence of prior and concurrent Barrett's oesophagus in oesophageal adenocarcinoma patients

Tan

Mansour

White

et al. 2020

Aliment Pharmacol Ther

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Summary Background The proportions of patients with oesophageal adenocarcinoma (OAC) diagnosed by Barrett's oesophagus surveillance or with pre‐existing Barrett's oesophagus are unclear. Aim To estimate the prevalence of prior and concurrent Barrett's oesophagus diagnosis among patients with OAC or oesophagogastric junction adenocarcinomas (OGJAC). Methods We searched PubMed and Embase to identify studies published 1966‐1/8/2020 that examined the prevalence of prior (≥6 months) or concurrent Barrett's diagnosis (at cancer diagnosis) among OAC and OGJAC patients. Random effects models estimated overall and stratified pooled prevalence rates. Results A total of 69 studies, including 33 002 OAC patients (53 studies) and 2712 patients with OGJAC (28 studies) were included. The pooled prevalence of prior Barrett's oesophagus diagnosis in OAC was 11.8% (95% confidence interval [CI] 8.4%‐15.6%). The prevalence of prior Barrett's oesophagus diagnosis was higher in single‐centre resection studies (16.0%, 95% CI 8.7%‐24.9%) than population‐based cancer registry studies (8.4%, 95% CI 5.5%‐11.9%). The prevalence of concurrent Barrett's oesophagus in OAC was 56.6% (95% CI 48.5%‐64.6%). Studies with 100% early stage OAC had higher prevalence of concurrent Barrett's oesophagus (91.3%, 95% CI 82.4%‐97.6%) than studies with <50% early OAC (39.7%, 95% CI 33.7%‐45.9%). In OGJAC, the prevalence of prior and concurrent Barrett's oesophagus was 23.2% (95% CI 7.5%‐44.0%) and 26.3% (95% CI 17.8%‐35.7%), respectively. Conclusions Most patients with OAC have Barrett's oesophagus. Our meta‐analysis found ~12% of OAC patients had prior Barrett's diagnosis, but concurrent Barrett's oesophagus was found in ~57% at the time of OAC diagnosis. This represents a considerable missed opportunity for Barrett's oesophagus screening.

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“…The effectiveness of RFA in eradicating HG dysplasia ranges from 74.4% to 100%, and the success of eradication of IM ranges from 41% to 100% (Table 2) [8, 10–25]. …”

Section: Treatment Efficacymentioning

confidence: 99%

“…The most common complication associated with esophageal RFA is posttreatment stricture formation with a reported incidence up to 19% [4, 8, 10–16, 21–25]. …”

Section: Complicationsmentioning

confidence: 99%

Outcomes of Radiofrequency Ablation for Dysplastic Barrett’s Esophagus: A Comprehensive Review

Luigiano

Iabichino

Eusebi

et al. 2016

Gastroenterology Research and Practice

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Barrett's esophagus is a condition in which the normal squamous lining of the esophagus has been replaced by columnar epithelium containing intestinal metaplasia induced by recurrent mucosal injury related to gastroesophageal reflux disease. Barrett's esophagus is a premalignant condition that can progress through a dysplasia-carcinoma sequence to esophageal adenocarcinoma. Multiple endoscopic ablative techniques have been developed with the goal of eradicating Barrett's esophagus and preventing neoplastic progression to esophageal adenocarcinoma. For patients with high-grade dysplasia or intramucosal neoplasia, radiofrequency ablation with or without endoscopic resection for visible lesions is currently the most effective and safe treatment available. Recent data demonstrate that, in patients with Barrett's esophagus and low-grade dysplasia confirmed by a second pathologist, ablative therapy results in a statistically significant reduction in progression to high-grade dysplasia and esophageal adenocarcinoma. Treatment of dysplastic Barrett's esophagus with radiofrequency ablation results in complete eradication of both dysplasia and of intestinal metaplasia in a high proportion of patients with a low incidence of adverse events. A high proportion of treated patients maintain the neosquamous epithelium after successful treatment without recurrence of intestinal metaplasia. Following successful endoscopic treatment, endoscopic surveillance should be continued to detect any recurrent intestinal metaplasia and/or dysplasia. This paper reviews all relevant publications on the endoscopic management of Barrett's esophagus using radiofrequency ablation.

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Surgical and endoscopic management of high grade dysplasia and early oesophageal adenocarcinoma

Cited by 16 publications

References 19 publications

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis

Recurrence of intestinal metaplasia and early neoplasia after endoscopic eradication therapy for Barrett’s esophagus: a systematic review and meta-analysis

Systematic review with meta‐analysis: prevalence of prior and concurrent Barrett's oesophagus in oesophageal adenocarcinoma patients

Outcomes of Radiofrequency Ablation for Dysplastic Barrett’s Esophagus: A Comprehensive Review

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