Early Barrett's Neoplasia Research Articles

Radiofrequenzablation mit dem HALO-System in der Behandlung des Barrett-Ösophagus

In recent years radiofrequency ablation using the HALO system in the treatment of Barrett's oesophagus has become established. The HALO system consists of a circumferential ablation using a balloon-based electrode and a focal ablation using an endoscope-mounted bipolar electrode on an articulated platform. In combination with prior endoscopic resection radiofrequency ablation is a valuable therapeutic technique in selected patients with early Barrett's neoplasia. Clinical trials demonstrate that radiofrequency ablation is highly effective and durable, has low complication rates, preserves the functional integrity of the oesophagus, is easy to apply and the regenerating neosquamous epithelium is free of pre-existing oncogenetic alterations.

PWE-192 Efficacy and safety of extensive endomucosal resection for complete Barrett's eradication in early Barrett's neoplasia: a meta-analysis

IntroductionThe efficacy of complete Barrett's eradication by extensive endomucosal resection (E-EMR) of Barrett's oesophagus with early cancer ranges from 60% to 100% with a post-resection stricture rate of up to...

PTU-198 Towards objective endoscopic diagnosis of early Barrett's neoplasia using fibre-optic Raman spectroscopy

IntroductionRaman spectroscopy is a powerful analytical technique that can rapidly and accurately identify biochemical changes in cells that have become neoplastic. We are aiming to translate this laboratory technique into...

Tu1110 Clinical Impact of Autofluorescence Imaging on the Endoscopic Treatment for Early Barrett's Neoplasia: A Prospective Assessment of 371 Patients

Tu1110 Clinical Impact of Autofluorescence Imaging on the Endoscopic Treatment for Early Barrett's Neoplasia: A Prospective Assessment of 371 Patients

242 Diagnosis of Early Barrett's Neoplasia and Esophageal Squamous Cell Neoplasia by Electrical Bio-Impedance Spectroscopy in Human Tissue

Detection of early esophageal cancer in surrounding normal tissue can be challenging even for experienced examiners. Early detection is essential to determine the following treatment. Early stages of esophageal cancers can be treated by endoscopic resection (ER) whereas advanced neoplasias might lead to esophagectomy. Diagnosis is usually made by biopsies of suspicious lesions or untargeted quadrant biopsies. The electrical properties in inflammatory tissue and dysplasia can be sensed by electrical bioimpedance technique.

Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett's esophagus

Whether early Barrett's neoplasia has a predilection for particular spatial locations in shorter segment disease is currently unknown. Anatomic factors may play a role in lesion location because of differing levels of mucosal acid exposure. To identify high-risk lesion locations, which has important implications for surveillance strategies. We interrogated a prospectively maintained database of patients who underwent endoscopic resection (ER) for Barrett's neoplasia at 2 Australian tertiary centers. Lesions targeted for ER were characterized and their location in the distal esophagus was noted as on a clock face. A Z test of proportions was used to test for deviation from uniformity in the distribution of lesions. Two Australian tertiary centers. Patients who underwent ER for Barrett's neoplasia. Lesion location in the distal oesophagus, resected specimen histology. A total of 146 consecutive patients had ER for biopsy-proven high-grade dysplasia or esophageal adenocarcinoma. A total of 75 patients had Barrett's segment length of 5 cm or less and a visible lesion. Five patients had 2 visible lesions giving a total of 80 lesions. ER of 66 lesions (82.5%) led to the identification of advanced pathology: 37 high-grade dysplasia (46%), 24 mucosal adenocarcinoma (30%), 5 submucosal adenocarcinoma (6%). Of a total of 80 lesions, 43 (53.8%) (95% CI, 42.9%-64.7%) were centered within the 2- to 5-o'clock arc, comprising 25% of the circumference. This area also accounted for 36 (54.5%) of the 66 lesions with advanced histology (95% CI, 42.5%-66.5%). All confidence intervals lie wholly above the 25% expected in a uniform circular distribution (P < .05). Observational study in a tertiary center. In Barrett's maximal segments of 5 cm or less, the 2- to 5-o'clock arc, accounts for approximately 50% of macroscopically visible lesions and associated early neoplasia. This finding has important implications for surveillance strategies.

Endoscopic Therapy of Esophageal Premalignancy and Early Malignancy

Esophageal adenocarcinoma (EAC) is an often deadly cancer with a rising incidence in Western countries. Chronic gastroesophageal reflux disease is associated with the metaplastic transformation of normal squamous epithelium to premalignant specialized intestinal metaplasia within the esophagus (Barrett's esophagus). Barrett's esophagus may progress to low-grade dysplasia (LGD), high-grade dysplasia (HGD), or even EAC. Although nondysplastic Barrett's esophagus progresses to EAC at a rate of 0.5% per year, rates of progression for true LGD and HGD are significantly higher. Treatment is mandatory for HGD and may be appropriate in select patients with nondysplastic Barrett's esophagus and many with LGD. Thus, accurate pathologic assessment is necessary before considering endoscopic therapy. Previously, only esophagectomy was offered to patients with HGD or EAC. However, esophagectomy has significant morbidity and mortality, and therefore endoscopic therapies have been advocated for early Barrett's neoplasia. These methods include endoscopic mucosal resection (EMR) and ablative techniques. Ablation techniques include argon plasma coagulation, multipolar electrocoagulation, laser therapy, photodynamic therapy, radiofrequency ablation, and cryotherapy. Of these, radiofrequency ablation has experienced the greatest adoption for the treatment of dysplastic Barrett's esophagus because of excellent published outcomes. The use of EMR to resect suspicious areas or raised lesions is mandatory to provide histology. In contrast, ablation techniques such as radiofrequency ablation have been shown to effectively eradicate large areas of dysplastic tissue with relative ease but do not allow for histologic assessment of the treated area. Combination EMR with radiofrequency ablation is thus advocated to resect visible lesions via EMR (providing histology) and ablate the remainder of the Barrett's esophagus. As always, the appropriate treatment is best determined after careful discussion with patients in a multidisciplinary environment. However, endoscopic therapy offers an attractive alternative to esophagectomy for early Barrett's neoplasia.

Randomized trial on endoscopic resection-cap versus multiband mucosectomy for piecemeal endoscopic resection of early Barrett's neoplasia

Endoscopic resection (ER) is an important treatment for high-grade intraepithelial neoplasia and early cancer in Barrett's esophagus. ER-cap requires submucosal lifting and positioning of a snare in the cap, making it technically demanding and laborious. Multiband mucosectomy (MBM) uses a modified variceal band ligator and requires no submucosal lifting or positioning of a snare. To compare ER-cap and MBM for piecemeal ER of early Barrett's neoplasia. Randomized, controlled trial. Tertiary-care and community-care centers. This study involved 84 patients (64 men; median age 70 years) undergoing piecemeal ER of Barrett's neoplasia. Piecemeal ER was performed by using ER-cap (n = 42) or MBM (n = 42). Safety, efficacy, procedure time, costs. Procedure time (34 vs 50 minutes; P = .02) and costs (€240 vs €322; P < .01) were significantly less with MBM compared with ER-cap. MBM resulted in smaller resection specimens than ER-cap (18 ×13 mm vs 20 × 15 mm; P < .01). Maximum thicknesses of specimens and resected submucosa were not significantly different. There were no clinically relevant bleeding episodes. Four perforations occurred, 3 with ER-cap, 1 with MBM (P = not significant). Potential bias because of different levels of experience among participating endoscopists. Piecemeal ER with MBM is faster and cheaper than with ER-cap. Despite the lack of submucosal lifting, MBM appears not to be associated with more perforations. Although MBM results in slightly smaller specimens, the clinical relevance of this may be limited because depth of resections does not differ between both techniques. MBM may thus be preferred for piecemeal ER of early Barrett's neoplasia. ( NTR1435.).

Frühes Ösophaguskarzinom: Pro endoskopische Resektion

In several publications including more than 1,000 endoscopically treated patients it could be demonstrated that endoscopic treatment of early esophageal cancer is effective and safe. A combination of endoscopic resection (ER) of early Barrett's neoplasia followed by ablation of the remaining non-dysplastic Barrett's mucosa was able to significantly reduce the rate of recurrence and metachronous neoplasia. Long-term complete remission rates of more than 95% can be achieved. Compared to esophagectomy, endoscopic treatment has only a very low complication rate and almost no mortality. Therefore, ER is the treatment of choice and recommended by several international guidelines. Esophageal resection only plays a minor role in patients with early esophageal cancer.

The First Prospective Study of the Impact of Endoscopic and Surgical Treatment of Early Barrett's Neoplasia in Barrett's Esophagus on Quality of Life and Fear of Cancer

The First Prospective Study of the Impact of Endoscopic and Surgical Treatment of Early Barrett's Neoplasia in Barrett's Esophagus on Quality of Life and Fear of Cancer

Sa1430 Does Endoscopic Ultrasound (EUS) Have a Role in the Pre-Therapeutic Algorithm of Barrett's Neoplasia? - Correlation Between EUS Findings and Final Staging by Endoscopic Mucosal Resection (EMR)

Sa1430 Does Endoscopic Ultrasound (EUS) Have a Role in the Pre-Therapeutic Algorithm of Barrett's Neoplasia? - Correlation Between EUS Findings and Final Staging by Endoscopic Mucosal Resection (EMR)

Sa1536 Efficacy and Safety of Extensive Endomucosal Resection for Complete Barrett's Eradication in Early Barrett's Neoplasia: A Meta-Analysis

The efficacy of complete Barrett's eradication by Extensive endomucosal resection (E-EMR) of Barrett's esophagus with early cancer ranges from 60-100% with a post-resection stricture rate of up to 50% (1).

Towards real-time ‘biochemical endoscopy’ for diagnosis of early barrett's neoplasia

IntroductionRaman spectroscopy is a powerful analytical technique that can rapidly and accurately identify biochemical changes in cells that have become neoplastic. We aim to transfer this laboratory based technique to...

Diagnostic role of endoscopic ultrasound in selecting patients with early barrett neoplasia for endoscopic therapy

IntroductionCorrect staging is essential in selecting patients with early oesophageal neoplasia for endoscopic therapy. We prospectively investigated the diagnostic value of endoscopic ultrasound (EUS) in predicting submucosal infiltration in early...

Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice

Endoscopic trimodal imaging (ETMI) may improve detection of early neoplasia in Barrett's esophagus (BE). Studies with ETMI so far have been performed in tertiary referral settings only. To compare ETMI with standard video endoscopy (SVE) for the detection of neoplasia in BE patients with an intermediate-risk profile. Multicenter, randomized, crossover study. Community practice. BE patients with confirmed low-grade intraepithelial neoplasia (LGIN) underwent both ETMI and SVE in random order (interval 6-16 weeks). During ETMI, BE was inspected with high-resolution endoscopy followed by autofluorescence imaging (AFI). All visible lesions were then inspected with narrow-band imaging. During ETMI and SVE, visible lesions were sampled followed by 4-quadrant random biopsies every 2 cm. Overall histological yield of ETMI and SVE and targeted histological yield of ETMI and SVE. A total of 99 patients (79 men, 63±10 years) underwent both procedures. ETMI had a significantly higher targeted histological yield because of additional detection of 22 lesions with LGIN/high-grade intraepithelial neoplasia (HGIN)/carcinoma (Ca) by AFI. There was no significant difference in the overall histological yield (targeted+random) between ETMI and SVE. HGIN/Ca was diagnosed only by random biopsies in 6 of 24 patients and 7 of 24 patients, with ETMI and SVE, respectively. Inspection, with high-resolution endoscopy and AFI, was performed sequentially. ETMI performed in a community-based setting did not improve the overall detection of dysplasia compared with SVE. The diagnosis of dysplasia is still being made in a significant number of patients by random biopsies. Patients with a confirmed diagnosis of LGIN have a significant risk of HGIN/Ca. ( ISRCTN91816824; NTR867.).

Original article: Quality of life after esophagectomy and endoscopic therapy for Barrett's esophagus with dysplasia

Esophagectomy (EG) and endoscopic therapy (ET) can eradicate Barrett's esophagus with early neoplasia. Their relative effect on quality of life is unknown. The 36-item Short Form Health Survey (SF-36) and Gastrointestinal Quality of Life Index (GIQLI) questionnaires were sent to all patients who underwent either EG or ET at our institution over the last 9 years. Groups were stratified by age and American Society of Anesthesia (ASA) class. Surveys were sent to 77 patients and completed by 14 EG (50%) and by 28 ET patients (57%). The average time between treatment and survey was 4 years in the ET group and 5 years in the EG group. There were no significant differences in SF-36 scores between EG and ET patients except for superior physical functioning among EG patients 65 and older QOL scores among EG and ET groups were not significantly different than sex age-matched controls. GIQLI scores were similar between ET and EG patients of all ages (P= 0.60). GIQLI scores were higher among younger ET patients than young EG patients (P= 0.049). GIQLI scores also tended to be higher among ASA 1 and 2 ET patients than ASA 1 and 2 EG patients, but this did not reach statistical significance (P= 0.09). EG and ET for early Barrett's neoplasia appear to have similar impact on QOL 1 year or more after treatment compared with age-matched controls. Negative QOL impact appears to be greater for younger patients undergoing EG than for ET.

Diagnosis of Early Neoplasia in Barrett’s Mucosa Based on Changes in Surface Structure. Comparative Stereo-Microscopic and Histological Investigations in 600 Endoscopically Resected Specimens.

In view of the rapidly increasing incidence of Barrett's carcinoma, a desirable aim would be to detect intraepithelial neoplasia and mucosal carcinoma via the endoscope. Where something new is growing, it should give rise to visible changes in surface structure, in particular, in the case of the early Barrett's neoplasia. The present study was carried out to investigate this hypothesis. A total of 600 formalin-fixed endoscopically resected specimens (317 patients) from Barrett's oesophagus were prospectively investigated by stereomicroscopy (magnification up to x 90). The surface structure was classified into regular (finely granulated or ridged gyriform) and irregular (coarsely granulated, polypoid elevated or depressed), and compared with the results of the histological evaluation. 88.5 % of the Barrett's carcinomas, and 76 % and 68 %, respectively, of the cases of high-grade and low-grade intraepithelial neoplasia were associated with an irregular surface structure. However, coarsely granulated mucosal surfaces, reflecting regenerative changes, were also found in 26 % of the cases of Barrett's mucosa without intraepithelial neoplasia. Despite formalin fixation, 68 - 88.5 % of the cases of early Barrett's neoplasia can be identified by stereo microscopy. This shows that high-resolution videoendoscopy or magnification endoscopy appears to be a highly suitable method for the targeted detection of early Barrett's neoplasia.

511p: Endoscopic Submucosal Resection (ESD) of Early Barrett's Neoplasia (EBN) With a Water-Jet HybridKnife (ESDH): First Prospective Clinical Trial

EMR of EBN has frequently to be done in a piecemeal fashion. This approach can impair the histological evaluation of the resected specimen and may increase the risk of residual or recurrent neoplasia. ESDH has shown to be superior to EMR of esophageal lesions in an experimental trial (GIE 2009;70:112-20) but has not yet been studied in patients with EBN.

587a: Safety Outcomes of Balloon-Based Circumferential Radiofrequency Ablation After Focal Endoscopic Resection of Early Barrett's Neoplasia in 118 Patients: Results of an Ongoing European Multicenter Study

587a: Safety Outcomes of Balloon-Based Circumferential Radiofrequency Ablation After Focal Endoscopic Resection of Early Barrett's Neoplasia in 118 Patients: Results of an Ongoing European Multicenter Study

High-resolution endoscopy and endoscopic ultrasound for evaluation of early neoplasia in Barrett’s esophagus

Endoscopic ultrasound (EUS) is useful for detecting depth of invasion and nodal involvement in patients with early Barrett's neoplasia (EBN), precluding endoscopic management. This study aimed to determine whether the lesion morphology of the EBN shown on high-resolution endoscopy predicts EUS and histologic tumor stage. Retrospective series from two tertiary referral centers were studied. Patients with EBN referred for EUS evaluation before treatment were identified, and data were collected from endoscopies, a database, and case notes. All patients had high-resolution endoscopy followed by radial EUS. This study included 50 patients (22 men) with a median age of 69 years (interquartile range, 60-79 years). Visible lesions in the Barrett's segment were described as Paris types 0-1 (n = 9), 0-IIb (n = 12), 0-IIa (n = 12), 0-IIa + IIc (n = 6), and 0-IIc (n = 5). Of the 50 patients, 46 (92%) had either EMR (n = 17), esophagectomy (n = 23), or both (n = 6). All 12 patients (100%) with Paris 0-IIb lesions had T0/T1 m staging on EUS confirmed with resection histology. The sensitivity for EUS T-staging for Paris classification was 71.4% for type 0-I, 100% for type 0-IIb, 83% for type 0-IIa, 66.7% for type 0-IIa + IIc, and 66.7% for type IIc. Overall, 8 (17%) of the 46 patients were understaged and 2 (4%) were overstaged. For detecting submucosal invasion, EUS had a sensitivity of 66%, a specificity of 93%, a negative predictive value of 85%, and a diagnostic accuracy of 84.4%. Submucosal invasion is detected by EUS for 26% of patients with EBN. The value of EUS staging before resection for type 0-IIb early Barrett's cancer (flat lesions) is limited because 100% of these lesions are limited to the mucosa. For the management algorithm in this selected cohort, the use of EUS should be reconsidered.