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https://www.readbyqxmd.com/read/29124122/patient-decision-making-and-clinical-outcomes-following-endoscopic-therapy-or-esophagectomy-for-barrett-s-neoplasia
#1
Robert Lockwood, Elissa Ozanne, Chin Hur, Patrick Yachimski
Background and study aims:  The objective of this study was to assess patient involvement in decision-making, decision confidence, and decision regret among patients who had undergone endoscopic eradication therapy (EET) or esophagectomy for Barrett's esophagus (BE) associated neoplasia. Patients and methods:  Patients with BE high grade dysplasia or intramucosal (T1a) adenocarcinoma who had undergone EET or esophagectomy were invited to complete a survey. Results:  The cohort included 50 subjects, 70 % (35/50) of whom had undergone EET and 30 % (15/50) of whom had undergone esophagectomy...
November 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/29103533/diagnosis-and-management-of-barrett-related-neoplasia-in-the-modern-era
#2
REVIEW
Lysandra Voltaggio, Elizabeth A Montgomery
Whereas in the past, pathologists were hesitant to diagnose high-grade dysplasia in patients with Barrett esophagus, because this diagnosis prompted esophagectomy, current international consensus is that endoscopic treatment is the management for high-grade dysplasia and intramucosal carcinoma. Furthermore, many centers advocate endoscopic ablation for low-grade dysplasia. As such, establishing a diagnosis of dysplasia has become the key step; separation between the grades of dysplasia is less critical. This article offers some criteria for separating dysplasia from reactive changes, discusses pitfalls in interpreting endoscopic mucosal resection specimens, and outlines management strategies...
December 2017: Surgical Pathology Clinics
https://www.readbyqxmd.com/read/29078688/endoscopic-mucosal-ablation-and-resection-of-barrett-s-esophagus-and-related-diseases
#3
REVIEW
Juan A Muñoz-Largacha, Virginia R Litle
The prevalence of gastroesophageal reflux disease as well as the incidence of Barrett's esophagus (BE) has increased in the Western world over the last decades. The chronic reflux of gastric secretions injuries the esophageal mucosa and triggers cellular and molecular changes inducing the transformation of the normal squamous mucosa into columnar metaplastic epithelium. BE is a premalignant condition that can progress to low-grade dysplasia, high-grade dysplasia and ultimately esophageal adenocarcinoma. An early diagnosis of dysplastic changes and the adoption of appropriate therapeutic approaches are essential to improve patient outcomes and survival...
2017: J Vis Surg
https://www.readbyqxmd.com/read/29036278/perceptions-of-risk-and-therapy-among-patients-with-barrett-s-esophagus-a-patient-survey-study
#4
M W Stier, N Lodhia, J Jacobs, D Nozicka, R Kavitt, U Siddiqui, I Waxman, V J Konda
Nondysplastic Barrett's esophagus has a risk of progression to esophageal adenocarcinoma as low as 0.18-0.3% per person per year, and low-grade dysplasia as low as 0.5%. While adherence to guidelines and selection of management options varies, little is known about what modifies patient decision-making. This study aims to evaluate and identify factors that influence patient perceptions of risk and decisions about management. An independently developed and piloted survey was administered to patients at an academic hospital...
September 21, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28979713/efficacy-and-safety-of-liquid-nitrogen-cryotherapy-for-treatment-of-barrett-s-esophagus
#5
Kristen Suchniak-Mussari, Charles E Dye, Matthew T Moyer, Abraham Mathew, Thomas J McGarrity, Eileen M Gagliardi, Jennifer L Maranki, John M Levenick
AIM: To evaluate the efficacy and safety of liquid nitrogen cryotherapy as a primary or rescue treatment for BE, with and without dysplasia, or intramucosal adenocarcinoma (IMC). METHODS: This was a retrospective, single-center study carried out in a tertiary care center including 45 patients with BE who was treatment-naïve or who had persistent intestinal metaplasia (IM), dysplasia, or IMC despite prior therapy. Barrett's mucosa was resected via EMR when clinically appropriate, then patients underwent cryotherapy until eradication or until deemed to have failed treatment...
September 16, 2017: World Journal of Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28819902/ablation-therapy-for-barrett-s-esophagus-new-rules-for-changing-times
#6
REVIEW
Nour Hamade, Prateek Sharma
PURPOSE OF REVIEW: In this review, we discuss different endoscopic techniques in the eradication of Barrett's esophagus (BE) as well as some controversies in the field of treatment. RECENT FINDINGS: Patients with T1a esophageal adenocarcinoma and BE of high-grade dysplasia should undergo endoscopic ablative therapy. The most studied technique to date is radiofrequency ablation. It can be combined with endoscopic mucosal resection in cases containing nodular and flat lesions...
August 17, 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28815063/the-impact-of-flexible-endoscopy-in-esophageal-surgery
#7
REVIEW
Alejandro Nieponice, Fabio Nachman, Adolfo Badaloni, Franco Ciotola, Cecilia Zubieta, Mauricio Ramirez
Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28579538/late-recurrence-of-barrett-s-esophagus-after-complete-eradication-of-intestinal-metaplasia-is-rare-final-report-from-ablation-in-intestinal-metaplasia-containing-dysplasia-trial
#8
RANDOMIZED CONTROLLED TRIAL
Cary C Cotton, W Asher Wolf, Bergein F Overholt, Nan Li, Charles J Lightdale, Herbert C Wolfsen, Sarina Pasricha, Kenneth K Wang, Nicholas J Shaheen
BACKGROUND & AIMS: The goal of treatment for Barrett's esophagus (BE) with dysplasia is complete eradication of intestinal metaplasia (CEIM). The long-term durability of CEIM has not been well characterized, so the frequency and duration of surveillance are unclear. We report results from a 5-year follow-up analysis of patients with BE and dysplasia treated by radiofrequency ablation (RFA) in the randomized controlled Ablation of Intestinal Metaplasia Containing Dysplasia (AIM) trial...
September 2017: Gastroenterology
https://www.readbyqxmd.com/read/28577773/esophagectomy-for-superficial-esophageal-neoplasia
#9
REVIEW
Thomas J Watson
Endoscopic therapies have become the standard of care for most cases of Barrett's esophagus with high-grade dysplasia or intramucosal adenocarcinoma. Despite a rapid and dramatic evolution in treatment paradigms, esophagectomy continues to occupy a place in the therapeutic armamentarium for superficial esophageal neoplasia. The managing physician must remain cognizant of the limitations of endoscopic approaches and consider surgical resection when they are exceeded. Esophagectomy, performed at experienced centers for appropriately selected patients with early-stage disease can be undertaken with the expectation of cure as well as low mortality, acceptable morbidity, and good long-term quality of life...
July 2017: Gastrointestinal Endoscopy Clinics of North America
https://www.readbyqxmd.com/read/28546793/current-management-of-low-grade-dysplasia-in-barrett-esophagus
#10
Gary W Falk
Low-grade dysplasia in Barrett esophagus remains an ongoing challenge in clinical management. Recent studies suggest an increased risk in progression of low-grade dysplasia to high-grade dysplasia and/or adenocarcinoma. This is especially seen when 1 or more expert gastrointestinal pathologist confirms the diagnosis and in the setting of low-grade dysplasia that persists on more than 1 endoscopy. In the setting of confirmed and persistent low-grade dysplasia, level 1 evidence supports endoscopic ablation as a treatment option for these patients, although continued surveillance remains a viable option...
April 2017: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28541099/cost-effectiveness-analysis-of-endoscopic-eradication-therapy-for-treatment-of-high-grade-dysplasia-in-barrett-s-esophagus
#11
Alex Filby, Matthew Taylor, Gideon Lipman, Laurence Lovat, Rehan Haidry
AIM: The aim was to evaluate the cost-effectiveness of endoscopic eradication therapy (EET) with combined endoscopic mucosal resection and radiofrequency ablation for the treatment of high-grade dysplasia (HGD) arising in patients with Barrett's esophagus compared with endoscopic surveillance alone in the UK. MATERIALS & METHODS: The cost-effectiveness model consisted of a decision tree and modified Markov model. A lifetime time horizon was adopted with the perspective of the UK healthcare system...
May 25, 2017: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/28455160/long-term-follow-up-results-of-stepwise-radical-endoscopic-resection-for-barrett-s-esophagus-with-early-neoplasia
#12
Kamar Belghazi, Frederike G I van Vilsteren, Bas L A M Weusten, Sybren L Meijer, Jacques J G H M Bergman, Roos E Pouw
BACKGROUND AND AIMS: Stepwise radical endoscopic resection (SRER) has shown to be effective in eradicating Barrett's esophagus (BE) and its associated dysplasia. The aim of this study was to assess the long-term durability after successful SRER for early Barrett's neoplasia. METHODS: Patients treated with SRER for BE ≤5 cm with high-grade dysplasia (HGD) or early cancer (EC) and who had reached complete eradication of intestinal metaplasia (CE-IM) and neoplasia (CE-neo) were included...
April 25, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28408991/transplantation-of-tissue-engineered-cell-sheets-for-stricture-prevention-after-endoscopic-submucosal-dissection-of-the-oesophagus
#13
Eduard Jonas, Sebastian Sjöqvist, Peter Elbe, Nobuo Kanai, Jenny Enger, Stephan L Haas, Ammar Mohkles-Barakat, Teruo Okano, Ryo Takagi, Takeshi Ohki, Masakazu Yamamoto, Makoto Kondo, Katrin Markland, Mei Ling Lim, Masayuki Yamato, Magnus Nilsson, Johan Permert, Pontus Blomberg, J-Matthias Löhr
BACKGROUND AND OBJECTIVE: Endoscopic mucosal dissection (ESD) is a treatment option for oesophagus tumours localized to the mucosa enabling en bloc removal of large lesions. The resulting larger mucosal defects have resulted in an increase in the occurrence of post-treatment strictures. Transplantation of autologous cell sheets, cultured from oral mucosa, has been shown to prevent post-ESD strictures. The aim of the study was to assess the efficacy and safety of cell sheet transplantation after oesophageal ESD in a Western patient population where reflux-associated pre-malignant and malignant conditions predominate...
December 2016: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28405317/changes-in-gene-expression-of-neo-squamous-mucosa-after-endoscopic-treatment-for-dysplastic-barrett-s-esophagus-and-intramucosal-adenocarcinoma
#14
Angelique Levert-Mignon, Michael J Bourke, Sarah J Lord, Andrew C Taylor, Antony R Wettstein, Melanie Edwards, Natalia K Botelho, Rebecca Sonson, Chatura Jayasekera, Oliver M Fisher, Melissa L Thomas, Finlay Macrae, Damian J Hussey, David I Watson, Reginald V Lord
BACKGROUND: Endoscopic therapy, including by radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR), is first line treatment for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal cancer (IMC) and may be appropriate for some patients with low-grade dysplasia (LGD). OBJECTIVE: The purpose of this study was to investigate the molecular effects of endotherapy. METHODS: mRNA expression of 16 genes significantly associated with different BE stages was measured in paired pre-treatment BE tissues and post-treatment neo-squamous biopsies from 36 patients treated by RFA (19 patients, 3 IMC, 4 HGD, 12 LGD) or EMR (17 patients, 4 IMC, 13 HGD)...
February 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28353175/current-concepts-in-treatment-of-barrett-s-esophagus-with-and-without-dysplasia
#15
Francisco Schlottmann, Marco G Patti
BACKGROUND: Around 10-15% of patients with gastroesophageal reflux disease will develop Barrett's esophagus (BE). The development of novel endoscopic modalities has changed the management of BE in the last decade. AIM: The aim of this study was to review the current evidence for the treatment of BE with and without dysplasia. RESULTS: In patients with BE without dysplasia, antireflux surgery should not be suggested as a modality to prevent the malignant transformation of BE, but its indications should be the same as for other patients with gastroesophageal reflux...
August 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28338468/endoscopic-mucosal-resection-for-high-grade-dysplasia-and-intramucosal-carcinoma-a-canadian-experience
#16
Denise Tami Yamashita, Chao Li, Drew Bethune, Harry Henteleff, James Ellsmere
BACKGROUND: Endoscopic mucosal resection (EMR) is increasingly being used as a first-line treatment for Barrett esophagus (BE) with high-grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC). We reviewed our experience with endoscopic treatment of BE with HGD and IMC at our institution with respect to eradication rates, complications and long-term recurrence. METHODS: We performed a single-centre retrospective review of all patients referred between October 2010 and August 2014 for EMR with dysplastic BE or IMC...
April 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28275832/endoscopic-treatment-of-high-grade-dysplasia-and-early-esophageal-cancer
#17
Francisco Schlottmann, Marco G Patti, Nicholas J Shaheen
BACKGROUND: The emergence of novel endoscopic modalities has challenged the role of surgery for patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or early esophageal adenocarcinoma. AIM: The aim of this study was to review the available evidence of the endoscopic treatment of HGD and early esopahgeal adenocarcinoma. RESULTS: For most patients with BE and HGD, endoscopic ablative therapy is the preferred treatment strategy...
July 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28258457/from-heartburn-to-barrett-s-esophagus-and-beyond
#18
Francisco Schlottmann, Marco G Patti, Nicholas J Shaheen
BACKGROUND: Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. About 10-15% of patients with GERD will develop Barrett's esophagus (BE). AIMS: The aims of this study were to review the available evidence of the pathophysiology of BE and the role of anti-reflux surgery in the treatment of this disease. RESULTS: The transformation of the squamous epithelium into columnar epithelium with goblet cells is due to the chronic injury produced by repeated reflux episodes...
July 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28258451/surgical-treatment-of-high-grade-dysplasia-and-early-esophageal-cancer
#19
Patrick J McLaren, James P Dolan
BACKGROUND: The treatment of early-stage esophageal cancer and high-grade dysplasia of the esophagus has changed significantly in recent years. Many early tumors that were traditionally treated with esophagectomy can now be resected with endoscopic therapy alone. These new endoscopic modalities can offer similar survival outcomes without the associated morbidity of a major operation. However, a number of these cases may still require surgical intervention as the best treatment option...
July 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28235596/outcomes-after-liquid-nitrogen-spray-cryotherapy-in-barrett-s%C3%A2-esophagus-associated-high-grade-dysplasia-and%C3%A2-intramucosal-adenocarcinoma-5-year-follow-up
#20
Fariha H Ramay, Qingping Cui, Bruce D Greenwald
BACKGROUND AND AIMS: Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for Barrett's esophagus (BE)-associated high-grade dysplasia (BE-HGD) and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking. AIMS: The aim of this study was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years. METHODS: In this single-center, retrospective study drawn from a prospective database, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for 3 to 5 years...
October 2017: Gastrointestinal Endoscopy
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