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Endoscopic mucosal resection in barrett's esophagus

Hiroki Osumi, Junko Fujisaki, Masami Omae, Tomoki Shimizu, Toshiyuki Yoshio, Akiyoshi Ishiyama, Toshiaki Hirasawa, Tomohiro Tsuchida, Yorimasa Yamamoto, Hiroshi Kawachi, Noriko Yamamoto, Masahiro Igarashi
OBJECTIVES: Siewert type II esophagogastric junction adenocarcinoma encompasses both gastric cardia adenocarcinoma (GCA) and Barrett's esophageal adenocarcinoma (BEA) due to short-segment Barrett's esophagus. We compared these two types of Siewert type II esophagogastric junction adenocarcinoma in terms of background factors and clinical outcomes of endoscopic submucosal dissection (ESD). METHODS: We enrolled 139 patients (142 lesions) who underwent ESD from 2006 to 2014 at our institution...
October 25, 2016: Gastric Cancer
Madhav Desai, Shreyas Saligram, Neil Gupta, Prashanth Vennalaganti, Ajay Bansal, Abhishek Choudhary, Sreekar Vennelaganti, Jianghua He, Mohammad Titi, Roberta Maselli, Bashar Qumseya, Mojtaba Olyaee, Irwing Waxman, Alessandro Repici, Cesare Hassan, Prateek Sharma
BACKGROUND & AIMS: Focal endoscopic mucosal resection followed by radiofrequency ablation (f-EMR+RFA) and step-wise or complete EMR(sEMR) are established strategies for eradication of Barrett's esophagus (BE)-related high-grade dysplasia(HGD) and/or intra-mucosal cancer(EAC/IMC). Objective of this study was to derive pooled rates of efficacy and safety of individual method in a large cohort of BE patients and to perform indirect comparison between 2 methods. METHODS: PubMed, Embase, Web of Science, Cochrane and major conference proceedings were searched...
September 23, 2016: Gastrointestinal Endoscopy
Jayaprakash Sreenarasimhaiah
In the last decade, the treatment of dysplastic Barrett's esophagus has evolved into primarily endoscopic therapy. Many techniques have become well-established to destroy or remove the mucosal lining of Barrett's esophagus. One of the newest therapies, cryospray ablation, has become a modality to treat both dysplastic Barrett's esophagus as well as esophageal carcinoma. In endoscopic applications, the cryogen used is either liquid nitrogen or carbon dioxide which causes tissue destruction through rapid freeze-thaw cycles...
August 25, 2016: World Journal of Gastrointestinal Endoscopy
Roxana M Coman, Takuji Gotoda, Christopher E Forsmark, Peter V Draganov
BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) carries significant advantages over endoscopic mucosal resection. As such, ESD is an established therapy for esophageal squamous cell carcinoma but there are only limited data on ESD as therapy for Barrett's esophagus (BE). Thus, we prospectively evaluated the outcomes of ESD in patients with BE with high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) performed in a Western center. PATIENTS AND METHODS: This is a prospective cohort study...
June 2016: Endoscopy International Open
Georgina R Cameron, Paul V Desmond, Chatura S Jayasekera, Francesco Amico, Richard Williams, Finlay A Macrae, Andrew C F Taylor
BACKGROUND AND STUDY AIMS: Radiofrequency ablation (RFA) combined with endoscopic mucosal resection (EMR) is effective for eradicating dysplastic Barrett's esophagus. The durability of response is reported to be variable. We aimed to determine the effectiveness and durability of RFA with or without EMR for patients with dysplastic Barrett's esophagus. PATIENTS AND METHODS: Patients with dysplastic Barrett's esophagus referred to two academic hospitals were assessed with high definition white-light endoscopy, narrow-band imaging, and Seattle protocol biopsies...
August 2016: Endoscopy International Open
Prashanthi N Thota, Alaa Sada, Madhusudhan R Sanaka, Sunguk Jang, Rocio Lopez, John R Goldblum, Xiuli Liu, John A Dumot, John Vargo, Gregory Zuccarro
BACKGROUND: Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor...
July 21, 2016: Surgical Endoscopy
Jan Martínek, Jun-Ichi Akiyama, Zuzana Vacková, Manuele Furnari, Edoardo Savarino, Teus J Weijs, Elen Valitova, Sylvia van der Horst, Jelle P Ruurda, Lucas Goense, George Triadafilopoulos
Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression...
July 8, 2016: Annals of the New York Academy of Sciences
Emilio Di Giulio, Stefano Angeletti, Federico Desideri
Recent-years technological innovation has achieved two important objectives: 1) to develop advanced diagnostic tools able to determine with a fair degree of accuracy the nature of a lesion by means of the simple endoscopic observation; 2) to improve the therapeutic approach to lesions, by extending the least-invasive endoscopic treatment also to lesions that in the past were referred to surgery. Advanced diagnostic methodologies have been achieved thanks to the introduction of high definition endoscopes and virtual chromo-endoscopy...
June 2016: Recenti Progressi in Medicina
Hany M Elsadek, Mamdouh M Radwan
Background. Endoscopic surveillance for early detection of dysplastic or neoplastic changes in patients with Barrett's esophagus (BE) depends usually on biopsy. The diagnostic and therapeutic role of endoscopic mucosal resection (EMR) in BE is rapidly growing. Objective. The aim of this study was to check the accuracy of biopsy for precise histopathologic diagnosis of dysplasia and neoplasia, compared to EMR in patients having BE and related superficial esophageal lesions. Methods. A total of 48 patients with previously diagnosed BE (36 men, 12 women, mean age 49...
2015: International Scholarly Research Notices
A May
The esophagus is one of the areas of the gastrointestinal tract, for which therapeutic concepts have changed the most over the last two decades. The most decisive advance is the development of endoscopic resection techniques for early esophageal carcinomas. These methods provide excellent short- and long-term results combined with very low morbidity and negligible mortality rates in comparison with surgical esophagectomy, especially in case of mucosal Barrett's adenocarcinoma. In addition, the endoscopic myotomy techniques in Zenker's diverticulum and spastic achalasia are new, attractive endoscopic treatment modalities...
August 2016: Der Internist
M Wilke, M Rathmayer, M Schenker, W Schepp
INTRODUCTION: Neoplastic changes (mild or high grade intraepithelial neoplasia (L- or HGIEN) or early cancer) in Barrett esophagus are treated with various methods. This study compares clinical-economical aspects of sole stepwise radical endoscopic resection (SRER) against combination treatment with EMR (Endoscopic mucosal resection) and RFA (radiofrequency ablation). MATERIAL AND METHODS: Based on clinical data from a randomized controlled trial 1 we developed an economic model for costs of treatment according to the German Hospital Remuneration System (G-DRG)...
May 2016: Zeitschrift Für Gastroenterologie
Stephan Hollerbach, Axel Wellmann, Peter Meier, Jeffery Ryan, Ramon Franco, Peter Koehler
BACKGROUND AND STUDY AIMS: The EndoRotor(®) is a novel, non-thermal, automated mechanical endoscopic resection system designed to remove benign mucosal neoplastic tissue throughout the gastrointestinal tract. It uses suction pressure to pull in mucosa and rapidly and precisely cut it while automatically transporting the samples to a collection trap for later histologic evaluation. PATIENTS AND METHODS: To study the technical properties and therapeutic potential of this new tool, we performed multiple upper and lower gastrointestinal endoscopic mucosal resections in three healthy live pigs...
April 2016: Endoscopy International Open
Jesica Brown, Benjamin Alsop, Neil Gupta, Daniel C Buckles, Mojtaba S Olyaee, Prashanth Vennalaganti, Vijay Naag Kanakadandi, Shreyas Saligram, Prateek Sharma
BACKGROUND AND AIMS: The safety and efficacy of radiofrequency ablation (RFA) in treatment of Barrett's esophagus (BE)-associated dysplasia has been well established. The effectiveness of focal and balloon RFA devices has not been compared. Therefore, the aim of our study was to assess the effectiveness of focal and balloon RFA devices in the treatment of BE by calculating absolute and percentage change in BE length with RFA therapy by comparing pre- and post-treatment BE length. PATIENTS AND METHODS: This is a retrospective cross-sectional study of patients who underwent at least one treatment with either focal and/or balloon RFA devices who were identified from two tertiary centers...
April 2016: United European Gastroenterology Journal
Maximilien Barret, Dalhia Thao Cao, Frédéric Beuvon, Sarah Leblanc, Benoit Terris, Marine Camus, Romain Coriat, Stanislas Chaussade, Frédéric Prat
INTRODUCTION: The possible benefit of endoscopic submucosal dissection (ESD) for early neoplasia arising in Barrett's esophagus remains controversial. We aimed to assess the efficacy and safety of ESD for the treatment of early Barrett's neoplasia. METHODS: All consecutive patients undergoing ESD for the resection of a visible lesion in a Barrett's esophagus, either suspicious of submucosal infiltration or exceeding 10 mm in size, between February 2012 and January 2015 were prospectively included...
April 2016: United European Gastroenterology Journal
Ian Holmes, Tressia Hing, Shai Friedland
BACKGROUND AND AIMS: Piecemeal endoscopic mucosal resection (EMR) is the standard treatment of nodular Barrett's esophagus dysplasia and T1a cancer. Piecemeal resection may be incomplete and makes precise histologic assessment difficult. Endoscopic submucosal dissection (ESD) is a technique that enables en-bloc resection but has not gained widespread acceptance due to its technical difficulty, risk and long procedure time. METHODS: We developed a protocol consisting of a combination of a limited ESD with supplementary EMR in the same session if necessary, designed to increase en-bloc resection of the most worrisome neoplastic area while maximizing the rate of complete resection of dysplasia...
April 12, 2016: Surgical Endoscopy
Lodhia Nayna, Whitcomb Emma, Konda Vani
PURPOSE OF REVIEW: The diagnosis and management of low-grade dysplasia (LGD) in Barrett's esophagus continue to evolve and vary in practice. Radiofrequency ablation (RFA) is now an acceptable option for the treatment of LGD. Therefore, the purpose of this review article is to present current literature on the diagnosis and management of LGD, and to explore when to optimally pursue RFA for the treatment of LGD. RECENT FINDINGS: The challenge of the management of LGD begins with its diagnosis...
July 2016: Current Opinion in Gastroenterology
Bashar J Qumseya, Sachin Wani, Madhav Desai, Amira Qumseya, Paul Bain, Prateek Sharma, Herbert Wolfsen
BACKGROUND & AIMS: Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett's esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR. METHODS: We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014...
August 2016: Clinical Gastroenterology and Hepatology
Ashley H Davis-Yadley, Kevin G Neill, Mokenge P Malafa, Luis R Pena
BACKGROUND: Barrett esophagus (BE) continues to be a major risk factor for developing esophageal adenocarcinoma. METHODS: We review the risk factors, diagnosis, and management of BE, with an emphasis on the most current endoscopic diagnostic modalities for BE. RESULTS: Novel diagnostic modalities have emerged to address the inadequacies of standard, untargeted biopsies, such as dye-based and virtual chromoendoscopy, endoscopic mucosal resection, molecular biomarkers, optical coherence tomography, confocal laser endomicroscopy, volumetric laser endomicroscopy, and endocytoscopy...
January 2016: Cancer Control: Journal of the Moffitt Cancer Center
Arvind J Trindade, Benley J George, Joshua Berkowitz, Divyesh V Sejpal, Matthew J McKinley
Methods and study aims: The incidence of esophageal cancer is rising despite increased surveillance efforts. Volumetric laser endomicroscopy (VLE) is a new endoscopic imaging tool that can allow for targeted biopsy of neoplasia in Barrett's esophagus. We report a series of 6 patients with long-segment Barrett's esophagus ( > 3 cm), who underwent a session of endoscopy with volumetric laser endomicroscopy, after a separate prior session of standard high-definition endoscopy with narrow band imaging (NBI) and random biopsies that did not reveal neoplasia...
March 2016: Endoscopy International Open
Lisa Cassani, James C Slaughter, Patrick Yachimski
OBJECTIVES: Multiple endoscopic sessions may be necessary for treatment and surveillance of Barrett's esophagus (BE)-associated neoplasia. Adherence to an endoscopic therapeutic regimen is important for longitudinal management of BE. The objective of this study was to identify the factors associated with adherence to therapy for BE-associated neoplasia. METHODS: We retrospectively identified patients with BE whom were referred to a tertiary center for endoscopic mucosal resection (EMR) or radiofrequency ablation (RFA) between 2009 and 2012...
February 2016: United European Gastroenterology Journal
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