Barrett's Esophagus Research Articles

Cholelithiasis and cholecystectomy increase the risk of gastroesophageal reflux disease and Barrett's esophagus.

Cholelithiasis or cholecystectomy may contribute to the development of gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC) through bile reflux; however, current observational studies yield inconsistent findings. We utilized a novel approach combining meta-analysis and Mendelian randomization (MR) analysis, to assess the association between them. The literature search was done using PubMed, Web of Science, and Embase databases, up to 3 November 2023. A meta-analysis of observational studies assessing the correlations between cholelithiasis or cholecystectomy, and the risk factors for GERD, BE, and EACwas conducted. In addition, the MR analysis was employed to assess the causative impact of genetic pre-disposition for cholelithiasis or cholecystectomy on these esophageal diseases. The results of the meta-analysis indicated that cholelithiasis was significantly linked to an elevated risk in the incidence of BE (RR, 1.77; 95% CI, 1.37-2.29; p < 0.001) and cholecystectomy was a risk factor for GERD (RR, 1.37; 95%CI, 1.09-1.72; p = 0.008). We observed significant genetic associations between cholelithiasis and both GERD (OR, 1.06; 95% CI, 1.02-1.10; p < 0.001) and BE (OR, 1.21; 95% CI, 1.11-1.32; p < 0.001), and a correlation between cholecystectomy and both GERD (OR, 1.04; 95% CI, 1.02-1.06; p < 0.001) and BE (OR, 1.13; 95% CI, 1.06-1.19; p < 0.001). After adjusting for common risk factors, such as smoking, alcohol consumption, and BMI in multivariate analysis, the risk of GERD and BE still persisted. Our study revealed that both cholelithiasis and cholecystectomy elevate the risk of GERD and BE. However, there is no observed increase in the risk of EAC, despite GERD and BE being the primary pathophysiological pathways leading to EAC. Therefore, patients with cholelithiasis and cholecystectomy should be vigilant regarding esophageal symptoms; however, invasive EAC cytology may not be necessary.

Association between hiatal hernia and Barrett's esophagus: an updated meta-analysis with trial sequential analysis.

Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE. The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE. A meta-analysis with trial sequential analysis. The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane Q test and I² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity. Forty-seven studies with 131,517 participants were included. Based on the unadjusted data from 47 studies, hiatal hernia was significantly associated with an increased risk of any length BE (OR = 3.91, 95% CI = 3.31-4.62, p < 0.001). The heterogeneity was significant (I² = 77%; p < 0.001) and the definition of controls (p = 0.014) might be a potential contributor to heterogeneity. Based on the adjusted data from 14 studies, this positive association remained (aOR = 3.26, 95% CI = 2.44-4.35, p < 0.001). The heterogeneity was also significant (I² = 65%; p < 0.001). Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE (LSBE) (OR = 10.01, 95% CI = 4.16-24.06, p < 0.001). The heterogeneity was significant (I² = 78%; p < 0.001). Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE (OR = 2.76, 95% CI = 2.05-3.71, p < 0.001). The heterogeneity was not significant (I² = 30%; p = 0.201). Hiatal hernia should be a significant risk factor for BE, especially LSBE. PROSPERO registration number CRD42022367376.

A Case of a Granular Cell Tumor Arising in a Patient with Long-segment Barrett's Esophagus.

Esophageal cell tumors are rare. Esophagogastroduodenoscopy performed on a 48-year-old woman revealed an elevated esophageal lesion and the presence of long-segment Barrett's esophagus. Endoscopic ultrasonography showed a 15 mm homogeneous hypoechoic tumor extending from the lamina propria mucosa to the submucosa. Pathological examination of the biopsy tissue revealed a sheet-like cluster of histiocytoid cells with an abundant eosinophilic granular cytoplasm. Immunohistochemical examination revealed S-100 (+) and CD68 (+), thus suggesting the diagnosis of a granular cell tumor. The tumor was resected by endoscopic submucosal dissection. Pathologically, the background mucosa was Barrett's mucosa. This is the first reported case of an esophageal granular cell tumor in long-segment Barrett's esophagus.

Adherence to quality indicators and best practices in surveillance endoscopy of Barrett's esophagus: A video-based assessment.

Background and study aims Adherence to quality indicators (QIs) and best practices (BPs) for endoscopic surveillance of Barrett's esophagus (BE) is low based on clinical documentation which is an inaccurate representation of events occurring during procedures. This study aimed to assess adherence to measurable QI and BP using video evaluation. Methods We performed a single center video-based retrospective review of surveillance endoscopies performed for BE ≥1 cm between March 1, 2018 and October 1, 2020. Adherence to QIs and BPs was assessed through video review and documentation. Videos were evaluated by five gastroenterologists. Interrater variability was determined using 10 videos before reviewing the remaining 128 videos. A generalized linear regression model was used to determine predictors of adherence to QIs and BPs. Results There were 138 endoscopies reviewed. Inspection with virtual chromoendoscopy (VC) occurred in 75 cases (54%) on video review with documentation in 50 of these cases (67%). Adherence to the Seattle protocol (SP) occurred in 74 cases (54%) on video review with documentation in 28 of these cases (38%). Use of VC or the SP was documented but not observed on video review in 16 (12%) and 30 (22%) cases, respectively. Length of BE was associated with increased use of the Prague classification (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.37) while years in practice was associated with a decreased likelihood of VC use (OR 0.93, 95% CI 0.88-0.99). Conclusions This study validates prior data demonstrating poor adherence to QIs and BPs and highlights discrepancies between clinical documentation and events occurring during procedures.

Causal relationships between dietary habits and Barrett's esophagus risk: a univariable and multivariable Mendelian randomization study.

Aims: Dietary habits are reported to be associated with Barrett's esophagus (BE) risk; however, whether there is a causal relationship remains controversial. Here, we systematically examined the causal effects of genetically predicted dietary habits on BE risk through a Mendelian randomization (MR) analysis approach. Methods: Data for exposures were obtained from the UK Biobank (UKB), while the summary-level data for outcomes were obtained from a large sample-size GWAS meta-analysis. Genetic variants associated with 17 ordinary dietary habits at the genome-wide significance level were regarded as instrumental variables (IVs). Univariable and multivariable MR analyses were conducted to explore the causal relationships between dietary habits and BE risk. Sensitivity analyses were implemented to evaluate robustness of the results and determine the potential pleiotropy bias. Results: Univariable MR (UVMR) analysis showed that genetic predisposition to alcohol intake frequency, cooked vegetable intake, beef intake, bread intake, fresh fruit intake, salad/raw vegetable intake, and dried fruit intake were associated with BE risk, with all P values <0.05. After adjusting confounders, the effects of four dietary habits on BE risk persisted; multivariable MR (MVMR) analysis revealed that alcohol intake frequency (adjusted odds ratio (OR) = 1.74 (1.34, 2.27); P = 3.42 × 10-5) was causally associated with higher BE risk, the cooked vegetable intake (adjusted OR = 2.64 (1.16, 5.97); P = 0.02) had suggestively increased BE risk, while higher consumption of bread (adjusted OR = 0.54 (0.32-0.91); P = 0.02) and fresh fruit (adjusted OR = 0.34 (0.15, 0.77); P = 0.01) were suggestively associated with lower BE risk. Conclusions: These MR analyses demonstrate evidence of causal relationships between dietary habits and BE risk. These findings provide new insights into targeted dietary intervention strategies for BE prevention.

Approach to esophageal absent contractility: can we do better?

Absent contractility (AC), a motility disorder characterized by the absence of esophageal contractions while maintaining normal lower esophageal sphincter relaxation, is recognized as a distinctive major disorder of peristalsis on esophageal high-resolution manometry that warrants comprehensive understanding. This unique motility disorder often co-occurs with connective tissue, rheumatologic or autoimmune diseases, with scleroderma being the classic example. Symptoms of gastroesophageal reflux are common. AC can profoundly impact patients' lives and result in a spectrum of complications, including erosive esophagitis, esophageal candidiasis, Barrett's esophagus, and malnutrition. To address the intricate complexities of AC and its multifaceted complications, a multidisciplinary approach is paramount. This approach considers the distinct clinical presentation and underlying rheumatologic conditions of the individual patient, recognizing the inherent diversity within this disorder. While medical management of gastroesophageal reflux remains the cornerstone of AC treatment, emerging surgical and endoscopic interventions offer additional therapeutic options for those grappling with this challenging condition. This comprehensive review provides an in-depth evaluation of recent advances in our understanding of AC and its management. It endeavors to offer valuable insights into therapeutic strategies for AC and its associated issues.

Establishing mouse and human oral esophageal organoids to investigate the tumor immune response.

Organoid culture systems are very powerful models that recapitulate in vivo organ development and disease pathogenesis, offering great promise in basic research, drug screening and precision medicine. However, the application of organoids derived from patients with cancer to immunotherapeutic research is a relatively untapped area. Esophageal cancer is one of the most lethal malignancies worldwide, including two major pathological subtypes: esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma. ESCC shares many biological and genomic features with oral squamous cell cancers. Herein, we provide a versatile protocol for the establishment and maintenance of oral and esophageal organoid cultures derived from both murine and human samples. We describe culture conditions for organoids derived from normal tongue, esophagus and gastroesophageal junction, esophageal cancer and Barrett's esophagus. In addition, we establish an ex vivo model by co-culturing patient tumor-derived organoids and autologous CD8+ T lymphocytes to assess CD8+ T cell-mediated tumor killing. Our protocol can also be modified for organoid establishment from other squamous epithelia and carcinomas. The co-culture model can serve as a template for studies of other tumor-immune cell interactions and the efficacy of immune checkpoint blockade therapy.

Esofagitis, esofagitis por reflujo y enfermedad por reflujo gastroesofágico

Esophagitis is defined as the presence of inflammatory disease in different layers of the esophagus. It is a common disease that has a wide variety of causes, with reflux esophagitis being the most frequent. Gastroesophageal reflux disease (GERD) is defined as the onset of symptoms or lesions secondary to sustained pathological reflux. The main triggering mechanism is transient relaxation of the lower esophageal sphincter. Clinically, it can give rise to typical manifestations (pyrosis and regurgitation) as well as extraesophageal manifestations. It is a chronic disease with a generally benign course, although it can lead to complications such as esophagitis or Barrett's esophagus and risk of progression to esophageal adenocarcinoma. In clinical practice, GERD is diagnosed empirically and treated based on the symptoms recorded by the clinician, although performing an upper gastrointestinal endoscopy and other additional tests are sometimes required for diagnosis and to rule out complications. Treatment is based on a combination of hygienic-dietary measures and medical treatment based on proton pump inhibitors. On some occasions, resorting to surgical treatment may be required.

DNA flow cytometry for detection of genomic instability as a cancer precursor in the gastrointestinal tract.

One of the earliest applications of flow cytometry was the measurement of DNA content in cells. This method is based on the ability to stain DNA in a stoichiometric manner (i.e., the amount of stain is directly proportional to the amount of DNA within the cell). For more than 40years, a number of studies have consistently demonstrated the utility of DNA flow cytometry as a potential diagnostic and/or prognostic tool in patients with most epithelial tumors, including pre-invasive lesions (such as dysplasia) in the gastrointestinal tract. However, its availability as a clinical test has been limited to few medical centers due to the requirement for fresh tissue in earlier studies and perceived technical demands. However, more recent studies have successfully utilized formalin-fixed paraffin-embedded (FFPE) tissue to generate high-quality DNA content histograms, demonstrating the feasibility of this methodology. This review summarizes step-by-step methods on how to perform DNA flow cytometry using FFPE tissue and analyze DNA content histograms based on the published consensus guidelines in order to assist in the diagnosis and/or risk stratification of many different epithelial tumors, with particular emphasis on dysplasia associated with Barrett's esophagus and inflammatory bowel disease.

Multifunctional Ablative Gastrointestinal Imaging Capsule (MAGIC) for Esophagus Surveillance and Interventions.

Objective and Impact Statement: A clinically viable technology for comprehensive esophagus surveillance and potential treatment is lacking. Here, we report a novel multifunctional ablative gastrointestinal imaging capsule (MAGIC) technology platform to address this clinical need. The MAGIC technology could also facilitate the clinical translation and adoption of the tethered capsule endomicroscopy (TCE) technology. Introduction: Recently developed optical coherence tomography (OCT) TCE technologies have shown a promising potential for surveillance of Barrett's esophagus and esophageal cancer in awake patients without the need for sedation. However, it remains challenging with the current TCE technology for detecting early lesions and clinical adoption due to its suboptimal resolution, imaging contrast, and lack of visual guidance during imaging. Methods: Our technology reported here integrates dual-wavelength OCT imaging (operating at 800 and 1300 nm), an ultracompact endoscope camera, and an ablation laser, aiming to enable comprehensive surveillance, guidance, and potential ablative treatment of the esophagus. Results: The MAGIC has been successfully developed with its multimodality imaging and ablation capabilities demonstrated by imaging swine esophagus ex vivo and in vivo. The 800-nm OCT imaging offers exceptional resolution and contrast for the superficial layers, well suited for detecting subtle changes associated with early neoplasia. The 1300-nm OCT imaging provides deeper penetration, essential for assessing lesion invasion. The built-in miniature camera affords a conventional endoscopic view for assisting capsule deployment and laser ablation. Conclusion: By offering complementary and clinically viable functions in a single device, the reported technology represents an effective solution for endoscopic screening, diagnosis, and potential ablation treatment of the esophagus of a patient in an office setting.

Gastroenterology and hepatology: what's new in 2023

2023 has been marked by numerous advancements in the fields of hepatology, liver transplantation, gastroenterology, and interventional endoscopy. These developments hold the promise of changing our daily practice while enhancing the diagnosis and treatment of various hepatic and gastroenterological conditions. Additionally, the European Association for the Study of the Liver (EASL) has issued recommendations for the management of hepatitis delta, acute-on-chronic liver failure, liver diseases of pregnancy, and intrahepatic cholangiocarcinoma. Risankizumab was approved by Swiss Authorities for patients with Crohn's disease and dupilumab was approved for patients with eosinophilic esophagitis. The European Society of Gastrointestinal Endoscopy (ESGE) has revised its recommendations regarding Barrett's esophagus.

Gastroesophageal junction cancer - current topic and treatment dilemmas

Treatment of gastroesophageal junction carcinomas have been debated for many years. This type of carcinomas has been classified as either gastric or esophageal carcinomas until Siewert's classification was established and they were defined as a distinct entity. Risk factors for development of these cancers are gastroesophageal reflux and Barrett's esophagus, obesity, Helycobacter pylori infection, smoking, and alcohol. Symptoms of this disease include retrosternal pain, dysphagia to aphagia and weight loss. Esophagogastroduodenoscopy with biopsy and pathohistological verification as well as CT of the chest and abdomen are crucial in establishing the diagnosis. Adenocarcinoma is predominant histological type of these tumors. The stage of the disease is defined by the TNM classification. Treatment of gastroesophageal junction cancer is complex, multidisciplinary and multi-modal, and involves the use of surgery, chemotherapy and radiotherapy, alone or in different combinations. Surgery is the major treatment modality for these tumors, especially in local stages. Radiotherapy is used in the treatment of these tumors in all stages of the disease, and especially in the multimodal treatment of locally advanced gastroesophageal junction cancer, both preoperatively and postoperatively, usually in combination with chemotherapy. Chemotherapy is used in the treatment of these cancers as preoperative, postoperative and systemic. Immunotherapy and target therapy, as new promising therapy is usually applied in a systemic and postoperative approach. Future directions in the treatment of these cancers are directed towards new surgical procedures, new types of immunotherapy, as well as new radiotherapy techniques.

Russell body esophagitis and Barrett's esophagus.

85-year-old woman being studied for anemia, an endoscopy is performed where there is evidence of two areas with metaplastic appearance in the distal portion of the esophagus, which are biopsied. Histologic exam reveals a lymphoplasmacytic infiltrate with the presence of Russell cells and foci of intestinal metaplasia without evidence of dysplasia. Although not the usual location, it must be acknowledged that there is a possibility of recognizing Russell bodies in the context of esophageal inflammation and its possible association with Barrett's esophagus.

Mixed Dementia Alzheimer and Lewy body with congenital diseases: Case Study

Objectives: Dementia due to Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the diseases that appear together, especially in elderly people. Still, clinical identification of dementia is difficult in such circumstances. Therefore, we conducted a case study with a comprehensive prospective clinical assessment and complete mental, physical, and psychiatric examination to diagnose such mixed cases clinically and for curative management of mixed dementia of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Case: a 76 years old woman have anxiety that fluctuated. The history of medical disorders, physical examination and supporting examinations, was found that the patient had hypertension, dyslipidemia, hypothyroidism in treatment, Barrett's esophagus in therapy, osteoarthritis genu dextra, history of malnutrition, breast cancer and hysterectomy. The patient was advised to administer antipsychotics because the patient's agitation was severe and the caregiver's distress was high. The patient improved with pharmacological therapy and family monitoring support. Conclusion: The diagnosis of mixed dementia patients (Alzheimer's disease (AD) and dementia with Lewy bodies (DLB)) with a medical history of congenital disease has overlapping symptoms so that very selective drug treatment is needed so as not to worsen the condition of other diseases. The supportive role of the family can help cure mixed Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) by creating a logbook of daily behavior and symptoms that appear in the patient.

Artificial intelligence system for the detection of Barrett's esophagus.

Barrett's esophagus (BE), which has increased in prevalence worldwide, is a precursor for esophageal adenocarcinoma. Although there is a gap in the detection rates between endoscopic BE and histological BE in current research, we trained our artificial intelligence (AI) system with images of endoscopic BE and tested the system with images of histological BE. To assess whether an AI system can aid in the detection of BE in our setting. Endoscopic narrow-band imaging (NBI) was collected from Chung Shan Medical University Hospital and Changhua Christian Hospital, resulting in 724 cases, with 86 patients having pathological results. Three senior endoscopists, who were instructing physicians of the Digestive Endoscopy Society of Taiwan, independently annotated the images in the development set to determine whether each image was classified as an endoscopic BE. The test set consisted of 160 endoscopic images of 86 cases with histological results. Six pre-trained models were compared, and EfficientNetV2B2 (accuracy [ACC]: 0.8) was selected as the backbone architecture for further evaluation due to better ACC results. In the final test, the AI system correctly identified 66 of 70 cases of BE and 85 of 90 cases without BE, resulting in an ACC of 94.37%. Our AI system, which was trained by NBI of endoscopic BE, can adequately predict endoscopic images of histological BE. The ACC, sensitivity, and specificity are 94.37%, 94.29%, and 94.44%, respectively.

The Salivary Microbiome and Predicted Metabolite Production Are Associated with Barrett's Esophagus and High-Grade Dysplasia or Adenocarcinoma.

Esophageal adenocarcinoma (EAC) is rising in incidence, and established risk factors do not explain this trend. Esophageal microbiome alterations have been associated with Barrett's esophagus (BE) and dysplasia and EAC. The oral microbiome is tightly linked to the esophageal microbiome; this study aimed to identify salivary microbiome-related factors associated with BE, dysplasia, and EAC. Clinical data and oral health history were collected from patients with and without BE. The salivary microbiome was characterized, assessing differential relative abundance of taxa by 16S rRNA gene sequencing and associations between microbiome composition and clinical features. Microbiome metabolic modeling was used to predict metabolite production. A total of 244 patients (125 non-BE and 119 BE) were analyzed. Patients with high-grade dysplasia (HGD)/EAC had a significantly higher prevalence of tooth loss (P = 0.001). There were significant shifts with increased dysbiosis associated with HGD/EAC, independent of tooth loss, with the largest shifts within the genus Streptococcus. Modeling predicted significant shifts in the microbiome metabolic capacities, including increases in L-lactic acid and decreases in butyric acid and L-tryptophan production in HGD/EAC. Marked dysbiosis in the salivary microbiome is associated with HGD and EAC, with notable increases within the genus Streptococcus and accompanying changes in predicted metabolite production. Further work is warranted to identify the biological significance of these alterations and to validate metabolic shifts. There is an association between oral dysbiosis and HGD/EAC. Further work is needed to establish the diagnostic, predictive, and causal potential of this relationship.

Gastroesophageal reflux disease, Barrett's esophagus. Pathophysiology, classification and treatment. Review

Introduction: The pathophysiology of Gastroesophageal Reflux Disease is reviewed as well as the classification of Barret's esophagus. Several therapeutic perspectives are addressed: the use of drugs, surgery, endoprosthesis and tissue regeneration therapies with stem cells. Objectives: To discuss the pathophysiology of GERD as well as the evolution of available treatments for this condition. To highlight the impact of stem cell therapy and the development of organoids for the reconstruction of esophageal regions such as the lower esophageal sphincter. Materials and methods:Pubmed and Google Scholar were searched using the keywords: gastroesophageal reflux disease, GERD, GERD physiopathology, digestive physiology, esophagus anatomy histology, Barrett's esophagus, Barrett's esophagus diagnosis, esophageal adenocarcinoma, GERD treatment, GERD surgery, GERD implants.Papers published from 2018 to 2022 inclusive were filtered by full text and sorted by "most recent". Reviews and original papers were included. Only those publicly available were consulted. Conclusion: GERD is a highly prevalent condition that is related to exposure to multiple environmental factors. Hydrogen retrodiffusion and variant gastric contents reaching the esophagus lead to metaplastic changes that may result in adenocarcinomas. Various diagnostic techniques such as VEDA, manometry, pHmetry, and impedancemetry also allow the monitoring and prognostic characterization of GERD. Nutritional prevention, lifestyle changes and pharmacological approach aim to favor the competence of the lower esophageal sphincter, as well as to decrease the production of hydrochloric acid and the overexposure of the esophageal mucosa. Surgery and translational medicine, such as stem cell tissue engineering, offer promising approaches for esophageal reconstruction, while the results obtained with organoids and 3D printing on biomatrices foreshadow the production of functional esophagi as part of new therapies for GERD.

Feasibility Study Utilizing NanoString's Digital Spatial Profiling (DSP) Technology for Characterizing the Immune Microenvironment in Barrett's Esophagus Formalin-Fixed Paraffin-Embedded Tissues.

Characterization of the Barrett's esophagus (BE) microenvironment in patients with a known progression status, to determine how it may influence BE progression to esophageal adenocarcinoma (EAC), has been understudied, hindering both the biological understanding of the progression and the development of novel diagnostics and therapies. This study's aim was to determine if a highly multiplex interrogation of the microenvironment can be performed on endoscopic formalin-fixed, paraffin-embedded (FFPE) samples, utilizing the NanoString GeoMx digital spatial profiling (GeoMx DSP) platform and if it can begin to identify the types of immune cells and pathways that may mediate the progression of BE. We performed a spatial proteomic analysis of 49 proteins expressed in the microenvironment and epithelial cells of FFPE endoscopic biopsies from patients with non-dysplastic BE (NDBE) who later progressed to high-grade dysplasia or EAC (n = 7) or from patients who, after at least 5 years follow-up, did not (n = 8). We then performed an RNA analysis of 1812 cancer-related transcripts on three endoscopic mucosal resections containing regions of BE, dysplasia, and EAC. Profiling with GeoMx DSP showed reasonable quality metrics and detected expected differences between epithelium and stroma. Several proteins were found to have an increased expression within NDBE biopsies from progressors compared to non-progressors, suggesting further studies are warranted.

Association between endoscopic evidence of bile reflux and Barrett's esophagus: A large-scale case-control study

BackgroundAlthough bile reflux plays an important role in the development of Barrett's esophagus, the relationship between endoscopic findings of bile reflux and Barrett's esophagus remains unclear. ObjectiveThis study evaluated whether endoscopic evidence of bile reflux was associated with the presence of Barrett's esophagus. MethodsA retrospective analysis of a prospectively maintained database comprising consecutive patients who underwent screening esophagogastroduodenoscopy was conducted. Endoscopic evidence of bile reflux was defined as the presence of bile-stained fluid in the gastric fundus. We performed multivariate analysis to identify predictive factors that differed significantly between patients with and without Barrett's esophagus. ResultsOf 4021 patients, 922 (23%) had Barrett's esophagus, and 1000 (25%) showed endoscopic findings of bile reflux. Multivariate analysis revealed endoscopic evidence of bile reflux as the strongest independent factor associated with the presence of Barrett's esophagus (odds ratio [OR] 5.65, 95% confidence interval [CI] 4.71–6.76) in relation to the presence of hiatal hernia (OR 3.30, 95% CI 2.70–4.04) and male gender (OR 1.54, 95% CI 1.24–1.91). ConclusionsEndoscopic evidence of bile reflux was independently associated with the presence of Barrett's esophagus. This finding might help identify patients at future risk of Barrett's esophagus who could benefit from increased endoscopy surveillance.

WATS 3D : An Interobserver Study of Barrett's Esophagus-Associated Dysplasia Among Gastrointestinal Pathologists.

Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS 3D ) has been shown to increase the detection rate of dysplasia (and intestinal metaplasia) in patients with Barrett's esophagus (BE). The purpose of this study was to evaluate the interobserver variability and accuracy of diagnosing BE-associated dysplasia in WATS 3D specimens among gastrointestinal (GI) pathologists without prior experience with this technology. Five GI pathologists underwent a 4-hour in-person (at microscope) and virtual training session and then evaluated digital images of discrete cellular foci from 60 WATS 3D cases with BE (20 nondysplastic BE [NDBE], 20 low-grade dysplasia [LGD], and 20 high-grade dysplasia/esophageal adenocarcinoma [HGD/EAC]). Each case consisted of 1 hematoxylin and eosin-stained image (cell block), and 1 liquid cytology or papanicolaou-stained smear image (120 images in total). The overall kappa value among the 5 study pathologists was excellent (overall kappa = 0.93; kappa = 0.93 and 0.97 for cell block and smear specimens, respectively). There were no significant differences noted in kappa values in interpretation of the cell block vs smear specimens or in any of the individual diagnostic categories when the latter were evaluated separately. Furthermore, agreement was perfect (100%) regarding detection of neoplasia (either LGD, HGD, or EAC). Diagnoses were made with complete confidence in 91% of instances. We conclude that GI pathologists, without any prior experience in interpretation of WATS 3D specimens, can undergo a short training session and then diagnose these specimens with a very high level of accuracy and reproducibility.