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Dysplasia in Barrett's esophagus

Prashanthi N Thota, Zubin Arora, John A Dumot, Gary Falk, Tanmayee Benjamin, John Goldblum, Sunguk Jang, Rocio Lopez, John J Vargo
BACKGROUND AND AIMS: Endoscopic ablation therapy has become the mainstay of treatment of Barrett's associated dysplasia and intramucosal cancer (IMC). The widely available techniques for ablation are radiofrequency ablation (RFA) and cryotherapy. Our aim was to compare eradication rates of metaplasia and dysplasia with both these modalities. PATIENTS AND METHODS: Retrospective review of prospectively collected database of patients who underwent endoscopic therapy for Barrett's dysplasia or IMC from 2006 to 2011 was performed...
March 9, 2018: Digestive Diseases and Sciences
Marcel Tanţău, Mihaela Laszlo, Alina Tanţău
Barrett's Esophagus (BE) is defined as a premalignant condition, where the esophageal squamous epithelium is replaced by intestinal epithelium. Specialized intestinal columnar metaplasia, typical for Barrett's esophagus, does not generate any symptoms. Most of the patients are initially seen for symptoms associated with the gastroesophageal reflux disease (GERD), such as heartburn, regurgitation and dysphagia. The histological progression from intestinal metaplasia to dysplasia and then to BE-associated adenocarcinoma forms the argument for screening and endoscopic monitoring...
January 2018: Chirurgia
M Harrison, J E Allen, V S Gorrepati, J M E López-Jamar, P Sharma
Barrett's esophagus progresses to esophageal adenocarcinoma in a stepwise histological fashion of no dysplasia, low grade dysplasia, high grade dysplasia and cancer. Hence the progression to cancer from various histological stages is different. Progression to cancer from low grade dysplasia is highly variable in the literature due to high inter-observer variability between pathologists in diagnosing it. Studies have shown the utility of having confirmation of low grade dysplasia by expert pathologists or documenting its persistence on two subsequent endoscopies in order to unify the diagnosis...
March 1, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Tuure Saarinen, Ulla Kettunen, Kirsi H Pietiläinen, Anne Juuti
BACKGROUND: Consensus on the necessity of esophagogastroduodenoscopy (EGD) before bariatric surgery is lacking. Recommendations and practices vary by country and unit. Several reports have expressed concerns on gastroesophageal reflux disease (GERD) and its consequences after sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in the excluded stomach after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: We explored the number and types of clinically significant findings in preoperative EGDs and how they associate with preexisting GERD-symptoms (SG) and premalignant lesions (RYGB)...
February 14, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Kavel Visrodia, Liam Zakko, Siddharth Singh, Cadman L Leggett, Prasad G Iyer, Kenneth K Wang
BACKGROUND AND AIMS: A small but significant proportion of patients with Barrett's esophagus (BE) have persistent dysplasia or intestinal metaplasia (IM) after treatment with radiofrequency ablation (RFA). Cryotherapy is a cold-based ablative modality that is increasingly being used in this setting. We aimed to better understand the efficacy of second-line cryotherapy in BE patients with persistent dysplasia or IM after RFA by conducting a systematic review and meta-analysis. METHODS: We performed a systematic literature search of PUBMED, EMBASE, and Web of Sciences through September 1, 2017...
February 21, 2018: Gastrointestinal Endoscopy
Don Chamil Codipilly, Apoorva Krishna Chandar, Siddharth Singh, Sachin Wani, Nicholas J Shaheen, John M Inadomi, Amitabh Chak, Prasad G Iyer
BACKGROUND & AIMS: Guidelines recommend endoscopic surveillance of patients with Barrett's esophagus (BE) to identify those with dysplasia (a precursor of carcinoma) or early-stage esophageal adenocarcinoma (EAC), who can be treated endoscopically. However, it is unclear whether surveillance increases survival times of patients with BE. We performed a systematic review and meta-analysis to qualitatively and quantitatively examine evidence for the association of endoscopic surveillance in patients with BE with survival and other outcomes...
February 16, 2018: Gastroenterology
Mohammad Alshelleh, Sumant Inamdar, Matthew McKinley, Molly Stewart, Jeffrey S Novak, Ronald E Greenberg, Keith Sultan, Bethany Devito, Mary Cheung, Maurice A Cerulli, Larry S Miller, Divyesh V Sejpal, Anil K Vegesna, Arvind J Trindade
BACKGROUND AND AIMS: Volumetric laser endomicroscopy (VLE) is a new wide field advanced imaging technology for Barrett's esophagus (BE). No data exist on incremental yield of dysplasia detection. Our aim is to report the incremental yield of dysplasia detection in BE using VLE. METHODS: This is a retrospective study from a prospectively maintained database from 2011-2017 comparing the dysplasia yield of 4 different surveillance strategies in an academic BE tertiary care referral center...
February 2, 2018: Gastrointestinal Endoscopy
Carol Rouphael, Afrin Kamal, Madhusudhan R Sanaka, Prashanthi N Thota
Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B (UVB) radiation...
January 15, 2018: World Journal of Gastrointestinal Oncology
André A Neves, Massimiliano Di Pietro, Maria O'Donovan, Dale J Waterhouse, Sarah E Bohndiek, Kevin M Brindle, Rebecca C Fitzgerald
BACKGROUND AND STUDY AIMS:  Endoscopic surveillance for Barrett's esophagus (BE) is limited by long procedure times and sampling error. Near-infrared (NIR) fluorescence imaging minimizes tissue autofluorescence and optical scattering. We assessed the feasibility of a topically applied NIR dye-labeled lectin for the detection of early neoplasia in BE in an ex vivo setting. METHODS:  Consecutive patients undergoing endoscopic mucosal resection (EMR) for BE-related early neoplasia were recruited...
January 17, 2018: Endoscopy
Fergus Chedgy, Carole Fogg, Kesavan Kandiah, Hugh Barr, Bernard Higgins, Mimi McCord, Ann Dewey, John De Caestecker, Lisa Gadeke, Clive Stokes, David Poller, Gaius Longcroft-Wheaton, Pradeep Bhandari
Background and study aims : Barrett's esophagus is a potentially pre-cancerous condition, affecting 375,000 people in the UK. Patients receive a 2-yearly endoscopy to detect cancerous changes, as early detection and treatment results in better outcomes. Current treatment requires random mapping biopsies along the length of Barrett's, in addition to biopsy of visible abnormalities. As only 13 % of pre-cancerous changes appear as visible nodules or abnormalities, areas of dysplasia are often missed...
January 2018: Endoscopy International Open
Stergios A Polyzos, Christos Zeglinas, Fotini Artemaki, Michael Doulberis, Evangelos Kazakos, Panagiotis Katsinelos, Jannis Kountouras
Esophageal adenocarcinoma (EAC) is etiologically associated with gastroesophageal reflux disease (GERD). There is evidence to support the sequence GERD, Barrett's esophagus (BE), dysplasia, and finally EAC, with Helicobacter pylori (H. pylori) being implicated in each step to EAC. On the other side of this relation stands the hypothesis of the protective role of H. pylori against EAC. Based on this controversy, our aim was to review the literature, specifically original clinical studies and meta-analyses linking H...
January 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
David Itskoviz, Zohar Levi, Doron Boltin, Alex Vilkin, Yifat Snir, Rachel Gingold-Belfer, Yaron Niv, Iris Dotan, Ram Dickman
BACKGROUND: Barrett's esophagus (BE) is a known complication of gastroesophageal reflux disease. In a previous study, we described a high prevalence of intestinal metaplasia (IM) in patients with an irregular Z line. However, the clinical importance of this finding is unclear. GOALS: To evaluate the long-term development of BE and relevant complications in patients diagnosed with an irregular Z line, with or without IM, on routine esophago-gastro-duodenoscopy (EGD)...
January 11, 2018: Digestive Diseases and Sciences
Yi-Quan Xiong, Shu-Juan Ma, Hao-Yue Hu, Jing Ge, Li-Zhi Zhou, Shu-Ting Huo, Min Qiu, Qing Chen
AIMS: Barrett's esophagus (BE) predisposes to the development of esophageal neoplasia, including high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). A systematic literature review and meta-analysis were performed to assess the accuracy of within-patient comparisons of narrow band imaging (NBI) and confocal laser endomicroscopy (CLE) for diagnosis of HGD/EAC in patients with BE. METHODS: The following databases were examined up to April 2016 without language restriction: PubMed, Embase, Medline, Web of Science and the Cochrane Library...
December 22, 2017: Clinics and Research in Hepatology and Gastroenterology
Sravanthi Parasa, Sreekar Vennalaganti, Srinivas Gaddam, Prashanth Vennalaganti, Patrick Young, Neil Gupta, Prashanthi Thota, Brooks Cash, Sharad Mathur, Richard Sampliner, Fouad Moawad, David Lieberman, Ajay Bansal, Kevin F Kennedy, John Vargo, Gary Falk, Manon Spaander, Marco Bruno, Prateek Sharma
BACKGROUND & AIMS: A system is needed to determine the risk of patients with Barrett's esophagus for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). We developed and validated a model to determine of progression to HGD or EAC in patients with BE, based on demographic data and endoscopic and histologic findings at the time of index endoscopy. METHODS: We performed a longitudinal study of patients with BE at 5 centers in United States and 1 center in Netherlands enrolled in the Barrett's Esophagus Study database from 1985 through 2014...
December 19, 2017: Gastroenterology
M Riegler, I Kristo, M Nikolic, E Rieder, S F Schoppmann
Background: Barrett's esophagus (BE) is the premalignant manifestation of gastroesophageal reflux disease (GERD). Radiofrequency ablation (RFA) with and without endoscopic resection (ER) is a novel treatment for BE. Methods: Here we present a single-center update of the recommendations of a recent (June 2015) interdisciplinary expert panel meeting on the management of BE with dysplasia as well as cancer-positive and cancer-negative BE. We conducted a PubMed search of studies published in 2016 and 2017 on the topic of BE and RFA...
2017: European Surgery: ACA: Acta Chirurgica Austriaca
J Ortiz-Fernandez-Sordo, S Sami, R Mansilla-Vivar, V Subramanian, J Mannath, E Telakis, K Ragunath
Infrared endoscopy (IRE) has been shown to be useful in detecting submucosal (SM) invasion in early gastric cancer. Its role in the endoscopic assessment of Barrett's neoplasia has not been reported to date. We aimed in this study to evaluate the role of IRE in the detection and characterization of early neoplastic lesions within Barrett's esophagus (BE). The secondary aim was to explore its usefulness for the assessment of the presence of submucosal invasion in these early neoplastic Barrett's lesions. We included in the study patients with dysplastic BE who were referred to our institution for endoscopic therapy of a previously diagnosed early Barrett's neoplasia...
December 8, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Masami Omae, Magnus Konradsson, Francisco Baldaque-Silva
A 71-year-old male patient with a long-segment (C10M12) Barrett's esophagus harboring multifocal high-grade dysplasia was referred to our clinic. After a multidisciplinary team conference and the patient's informed consent, an endoscopic submucosal dissection (ESD) was performed with resection of 4/5 of the esophageal circumference along 12 cm, without any complications during or immediately after the procedure. In the day after the ESD, the patient presented suddenly with dyspnea and subcutaneous emphysema in the neck and chest...
December 8, 2017: Clinical Journal of Gastroenterology
Hsin-Yu Fang, Natasha Stephens Münch, Margret Schottelius, Jonas Ingermann, Haibo Liu, Michael Schauer, Stefan Stangl, Gabriele Multhoff, Katja Steiger, Carlos Gerngroß, Moritz Jesinghaus, Wilko Weichert, Anja A Kühl, Antonia R Sepulveda, Hans-Jürgen Wester, Timothy C Wang, Michael Quante
Purpose: Barrett's esophagus represents an early stage in carcinogenesis leading to esophageal adenocarcinoma. Considerable evidence supports a major role for chronic inflammation and diverse chemokine pathways in the development of Barrett's esophagus and esophageal adenocarcinoma. Experimental Design: Here we utilized an IL1β transgenic mouse model of Barrett's esophagus and esophageal adenocarcinoma and human patient imaging to analyze the importance of CXCR4-expressing cells during esophageal carcinogenesis...
December 5, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
Hakan Akın, Yücel Aydın
Besides reducing the reflux symptoms, the benefit of proton pump inhibitors (PPI) in the treatment of Barrett's esophagus (BE) is not exactly known. The data in the literature show that although the PPI treatment does not reduce the Barrett's segment length, it can reduce dysplasia or the development of early-stage adenocarcinoma (odds ratio (OR): 0.46). Therefore, treatments with PPI may be considered in patients with a diagnosis of BE and at a high risk of adenocarcinoma, even though they are not symptomatic...
December 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Hakan Akın, Yücel Aydın
Barrett's esophagus (BE) is one of the major complications of gastroesophageal reflux disease (GERD) commonly encountered in gastroenterology clinics. A consensus has not been achieved yet with respect to the definition of BE in published guidelines. It is advised to use the Prague classification and not to use the definition of short and long segments for the endoscopic standardization of BE. Undertaking biopsies with white-light endoscopy from each of the 4 quadrants at 2-cm intervals is the standard method for the diagnosis of BE...
December 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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