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Mucosal Endoscopic Resection in Barrett's Oesophagus

Darina Kohoutova, Rehan Haidry, Matthew Banks, Mohammed Adil Butt, Jason Dunn, Sally Thorpe, Laurence Lovat
OBJECTIVE: Photodynamic therapy (PDT) was used as therapy for early neoplasia associated with Barrett's oesophagus (BE). This is 5-year follow-up of patients enrolled into randomised controlled trial of 5-aminolaevulinic acid (ALA) vs. Photofrin PDT. METHODS: Biopsies were taken from original Barrett's segment during endoscopic follow up using Seattle protocol. Endoscopic mucosal resection (EMR) ± radiofrequency ablation (RFA) was preferred therapy in patients who failed PDT and/or had recurrent neoplasia...
November 21, 2017: Scandinavian Journal of Gastroenterology
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
W K Tan, M di Pietro, R C Fitzgerald
Barrett's oesophagus is a condition which predisposes towards development of oesophageal adenocarcinoma, a highly lethal tumour which has been increasing in incidence in the Western world over the past three decades. There have been tremendous advances in the field of Barrett's oesophagus, not only in diagnostic modalities, but also in therapeutic strategies available to treat this premalignant disease. In this review, we discuss the past, present and future of Barrett's oesophagus. We describe the historical and new evolving diagnostic criteria of Barrett's oesophagus, while also comparing and contrasting the British Society of Gastroenterology guidelines, American College of Gastroenterology guidelines and International Benign Barrett's and CAncer Taskforce (BOBCAT) for Barrett's oesophagus...
July 2017: European Journal of Surgical Oncology
David C Whiteman, Bradley J Kendall
Barrett's oesophagus is a condition characterised by partial replacement of the normal squamous epithelium of the lower oesophagus by a metaplastic columnar epithelium containing goblet cells (intestinal metaplasia). Barrett's oesophagus is important clinically because those afflicted are predisposed to oesophageal adenocarcinoma. Prevalence surveys suggest that up to 2% of the population may be affected; most will be unaware of their diagnosis. Risk factors include age, male sex, gastro-oesophageal acid reflux, central obesity and smoking...
October 3, 2016: Medical Journal of Australia
J Ortiz-Fernández-Sordo, S Sami, R Mansilla-Vivar, J De Caestecker, A Cole, K Ragunath
OBJECTIVE: Evaluate the incidence of metachronous visible lesions (VLs) in patients referred for radiofrequency ablation (RFA) for early Barrett's neoplasia. DESIGN: This study was conducted as part of the service evaluation audit. SETTING: Tertiary referral centre. PATIENTS: All patients with dysplastic Barrett's oesophagus referred for RFA were included for analysis. White light high-resolution endoscopy (HRE), autofluorescence imaging and narrow band imaging were sequentially performed...
January 2016: Frontline Gastroenterology
Grischa Terheggen, Eva Maria Horn, Michael Vieth, Helmut Gabbert, Markus Enderle, Alexander Neugebauer, Brigitte Schumacher, Horst Neuhaus
BACKGROUND: For endoscopic resection of early GI neoplasia, endoscopic submucosal dissection (ESD) achieves higher rates of complete resection (R0) than endoscopic mucosal resection (EMR). However, ESD is technically more difficult and evidence from randomised trial is missing. OBJECTIVE: We compared the efficacy and safety of ESD and EMR in patients with neoplastic Barrett's oesophagus (BO). DESIGN: BO patients with a focal lesion of high-grade intraepithelial neoplasia (HGIN) or early adenocarcinoma (EAC) ≤3 cm were randomised to either ESD or EMR...
May 2017: Gut
Lauren G Khanna, Frank G Gress
The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection...
February 2015: Best Practice & Research. Clinical Gastroenterology
Christopher H Blevins, Prasad G Iyer
Barrett's oesophagus (BO) is thought to progress through the development of dysplasia (low grade and high grade) to oesophageal adenocarcinoma, a lethal cancer with poor survival. The overall goal of endoscopic therapy of BO is to eliminate metaplastic and dysplastic epithelium, to prevent and/or reduce the risk of progression to OAC. Endoscopic therapy techniques can be divided into two broad complementary techniques: tissue acquiring (endoscopic mucosal resection and endoscopic submucosal dissection) and ablative...
February 2015: Best Practice & Research. Clinical Gastroenterology
Rehan Haidry, Laurence Lovat, Prateek Sharma
Barrett's oesophagus is the only know pre-cursor to oesophageal adenocarcinoma. The incidence of OAC is growing rapidly in the western world with a poor prognosis for most with a 5-year survival of only 15%. The approach to treating patients with neoplasia arising within BE has dramatically changed in the past 5 years. Resection of visible lesions with endoscopic mucosal resection followed by field ablation with radio-frequency ablation is now the accepted standard of care in these patients worldwide. This combined approach has shown high rates of disease reversal in several high quality clinical trials but also large volume registry studies...
March 2015: Current Gastroenterology Reports
R J Haidry, M A Butt, J M Dunn, A Gupta, G Lipman, H L Smart, P Bhandari, L Smith, R Willert, G Fullarton, M Di Pietro, C Gordon, I Penman, H Barr, P Patel, N Kapoor, J Hoare, R Narayanasamy, Y Ang, A Veitch, K Ragunath, M Novelli, L B Lovat
BACKGROUND: Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia. METHODS: We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR...
August 2015: Gut
Zoe Oliphant, Alec Snow, Hannah Knight, Hugh Barr, L M Almond
BACKGROUND: Endoscopic resection (ER) is emerging as a curative technique in patients with high-grade dysplasia (HGD), intramucosal cancer (IMC), and early submucosal cancer (T1sm1) within Barrett's oesophagus. METHODS: This consecutive case series of 72 patients with HGD or IMC reports outcomes of ER, with or without mucosal ablation, in a single institution after a median of 38 months follow-up between 2004 and 2011. The primary outcome was disease progression to submucosal invasion...
November 2014: International Journal of Surgery
Hugh Barr, Catherine Kendall, Florian Bazant-Hegemark, Nicholas Stone
Photodynamic therapy is a very important technique for the eradication of widespread oesophageal mucosal disease which has the potential to degenerate to cancer. Patients unsuitable or unwilling to undergo radical therapy can be cured using photodynamic therapy. We predominantly treat patients with high-grade dysplasia in Barrett's oesophagus. Lesions that are visible macroscopically are removed using endoscopic mucosal resection. The remaining area is then treated in 5cm segments at 3 monthly intervals with separate photosensitisation using endoscopic photodynamic therapy...
June 2006: Photodiagnosis and Photodynamic Therapy
Hugh Barr
BACKGROUND: Cancer in the columnar-lined oesophagus develops through a multi-step process initiated by chronic gastro-oesophageal reflux progressing through metaplasia, low-grade dysplasia to high-grade dysplasia, which currently remains the best marker of cancer risk. Destruction of dysplasia using photodynamic therapy and other endoscopic methods may prevent cancer development. METHODS AND RESULTS: The potential problem in the columnar-lined oesophagus is surface limited to a depth of 0...
November 2004: Photodiagnosis and Photodynamic Therapy
F Kastelein, S van Olphen, E W Steyerberg, M Sikkema, M C W Spaander, C W N Looman, E J Kuipers, P D Siersema, M J Bruno, E W de Bekker-Grob
OBJECTIVE: Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance. DESIGN: We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression rates from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD) and OAC. Progression rates were incorporated in a decision-analytic model, including costs and quality of life data...
June 2015: Gut
Elizabeth C Smyth, David Cunningham
Oesophageal junctional adenocarcinoma is a challenging and increasingly common disease. Optimisation of pre-operative staging and consolidation of surgery in large volume centres have improved outcomes, however the preferred adjunctive treatment approach remains a matter of debate. This review examines the benefits of neoadjuvant, peri-operative, and post-operative chemotherapy and chemoradiotherapy in this setting in an attempt to reach an evidence based conclusion. Recent findings relating to the molecular characterisation of oesophagogastric cancer and their impact on therapeutics are explored, in addition to the potential benefits of fluoro-deoxyglucose positron emission tomography (FDG-PET) directed therapy...
June 15, 2014: World Journal of Gastrointestinal Oncology
Suzanne A Hopcroft, Neil A Shepherd
Pathological specimens from columnar-lined oesophagus (CLO) comprise a considerable proportion of the workload of gastrointestinal pathologists in Western countries. There remain controversies concerning the diagnostic role of pathology. More recently, in the UK at least, the diagnosis has been regarded as primarily an endoscopic endeavour, with pathology being corroborative and only diagnostic when endoscopic features are equivocal or when there are additional features that make the endoscopic diagnosis unclear...
October 2014: Histopathology
Mario Anders, Christina Bähr, Muhammad Abbas El-Masry, Andreas H Marx, Martin Koch, Stefan Seewald, Guido Schachschal, Andreas Adler, Nib Soehendra, Jakob Izbicki, Peter Neuhaus, Heiko Pohl, Thomas Rösch
BACKGROUND: Current endoscopic therapy for neoplastic Barrett's oesophagus (BO) consists of complete resection/ablation of all Barrett's tissue including neoplastic lesions. Recurrence seems to be frequent after thermal therapy, such as radiofrequency ablation. OBJECTIVE: To analyse long-term recurrence of neoplasia and BO after successful widespread endoscopic mucosal resection (EMR). DESIGN: In a retrospective analysis, all patients undergoing widespread EMR of neoplastic BO between 2002 and 2007 at two referral centres were followed for at least 3 years after completion of endotherapy...
October 2014: Gut
Yean Cheant Lim, Rebecca C Fitzgerald
INTRODUCTION: Barrett's oesophagus (BO) is a common premalignant condition, which carries a risk of progression to oesophageal adenocarcinoma. Recent advances include quantifying the risk of neoplasia progression, novel diagnostic tools and development of new endoscopic techniques to treat early Barrett's cancer. SOURCES OF DATA: A selective search was performed on recent advances in BO and this was supplemented with guidelines from the American and British Society of Gastroenterology...
2013: British Medical Bulletin
Emmanuel Coron, Michel Robaszkiewicz, Denis Chatelain, Magali Svrcek, Jean-François Fléjou
Adenocarcinoma developed in Barrett's oesophagus is a tumour with an increasing incidence and still a poor prognosis. The only marker that can be used for surveillance remains dysplasia (intraepithelial neoplasia), especially when it is high-grade, that precedes intramucosal carcinoma. New forms of dysplasia have been described in complement to the classical intestinal type (foveolar dysplasia, basal crypt dysplasia). High-grade dysplasia and intramucosal carcinoma are diagnosed on biopsies taken during endoscopy...
April 2013: Best Practice & Research. Clinical Gastroenterology
L Max Almond, Hugh Barr
The management of Barrett's oesophagus and associated neoplasia has evolved considerably in recent years. Modern endoscopic strategies including endoscopic resection and mucosal ablation can eradicate dysplastic Barrett's and prevent progression to invasive oesophageal cancer. However, several aspects of Barrett's management remain controversial including the stage in the disease process at which to intervene, and the choice of endoscopic or surgical therapy. A review of articles pertaining to the management of Barrett's oesophagus with or without associated neoplasia, was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
February 2014: Journal of Gastroenterology
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