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Patil DT, Odze RD. Barrett's Esophagus and Associated Dysplasia. Gastroenterol Clin North Am 2024; 53:1-23. [PMID: 38280743 DOI: 10.1016/j.gtc.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Early detection of dysplasia and effective management are critical steps in halting neoplastic progression in patients with Barrett's esophagus (BE). This review provides a contemporary overview of the BE-related dysplasia, its role in guiding surveillance and management, and discusses emerging diagnostic and therapeutic approaches that might further enhance patient management. Novel, noninvasive techniques for sampling and surveillance, adjunct biomarkers for risk assessment, and their limitations are also discussed.
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Affiliation(s)
- Deepa T Patil
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Robert D Odze
- Department of Pathology and Lab Medicine, Tufts University School of Medicine, Boston, MA, USA
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2
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Bartusik-Aebisher D, Osuchowski M, Adamczyk M, Stopa J, Cieślar G, Kawczyk-Krupka A, Aebisher D. Advancements in photodynamic therapy of esophageal cancer. Front Oncol 2022; 12:1024576. [PMID: 36465381 PMCID: PMC9713848 DOI: 10.3389/fonc.2022.1024576] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2023] Open
Abstract
The poor prognosis of patients with esophageal cancer leads to the constant search for new ways of treatment of this disease. One of the methods used in high-grade dysplasia, superficial invasive carcinoma, and sometimes palliative care is photodynamic therapy (PDT). This method has come a long way from the first experimental studies to registration in the treatment of esophageal cancer and is constantly being improved and refined. This review describes esophageal cancer, current treatment methods, the introduction to PDT, the photosensitizers (PSs) used in esophageal carcinoma PDT, PDT in squamous cell carcinoma (SCC) of the esophagus, and PDT in invasive adenocarcinoma of the esophagus. For this review, research and review articles from PubMed and Web of Science databases were used. The keywords used were "photodynamic therapy in esophageal cancer" in the years 2000-2020. The total number of papers returned was 1,000. After the review was divided into topic blocks and the searched publications were analyzed, 117 articles were selected.
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Affiliation(s)
- Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The University of Rzeszów, Rzeszów, Poland
| | | | - Marta Adamczyk
- Medical Faculty, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Stopa
- Medical College of The University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology, and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Bytom, Poland
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The University of Rzeszów, Rzeszów, Poland
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3
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de Souza LA, Mendel R, Strasser S, Ebigbo A, Probst A, Messmann H, Papa JP, Palm C. Convolutional Neural Networks for the evaluation of cancer in Barrett's esophagus: Explainable AI to lighten up the black-box. Comput Biol Med 2021; 135:104578. [PMID: 34171639 DOI: 10.1016/j.compbiomed.2021.104578] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/10/2023]
Abstract
Even though artificial intelligence and machine learning have demonstrated remarkable performances in medical image computing, their level of accountability and transparency must be provided in such evaluations. The reliability related to machine learning predictions must be explained and interpreted, especially if diagnosis support is addressed. For this task, the black-box nature of deep learning techniques must be lightened up to transfer its promising results into clinical practice. Hence, we aim to investigate the use of explainable artificial intelligence techniques to quantitatively highlight discriminative regions during the classification of early-cancerous tissues in Barrett's esophagus-diagnosed patients. Four Convolutional Neural Network models (AlexNet, SqueezeNet, ResNet50, and VGG16) were analyzed using five different interpretation techniques (saliency, guided backpropagation, integrated gradients, input × gradients, and DeepLIFT) to compare their agreement with experts' previous annotations of cancerous tissue. We could show that saliency attributes match best with the manual experts' delineations. Moreover, there is moderate to high correlation between the sensitivity of a model and the human-and-computer agreement. The results also lightened that the higher the model's sensitivity, the stronger the correlation of human and computational segmentation agreement. We observed a relevant relation between computational learning and experts' insights, demonstrating how human knowledge may influence the correct computational learning.
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Affiliation(s)
- Luis A de Souza
- Department of Computing, São Carlos Federal University - UFSCar, Brazil; Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Sophia Strasser
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Alanna Ebigbo
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - Andreas Probst
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - Helmut Messmann
- Medizinische Klinik III, Universitätsklinikum Augsburg, Germany
| | - João P Papa
- Department of Computing, São Paulo State University, UNESP, Brazil.
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), OTH Regensburg, Germany
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Abstract
Endoscopic eradication therapy (EET) with maximal acid suppression is the cornerstone for the management of patients with Barrett's esophagus (BE) associated dysplasia. The occurrence of buried dysplastic glands after re-epithelialization of a neo-squamous epithelium is of concern for endoscopists. Here, we present a patient with BE and high-grade dysplasia successfully treated by EET who developed buried dysplastic BE during surveillance. A review of literature on buried dysplasia after successful endoscopic therapy of BE is also discussed.
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Affiliation(s)
- Prabhat Kumar
- Department of Gastroenterology, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Prashanthi N Thota
- Department of Gastroenterology, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Yang S, Chen C, Qiu Y, Xu C, Yao J. Paying attention to tumor blood vessels: Cancer phototherapy assisted with nano delivery strategies. Biomaterials 2020; 268:120562. [PMID: 33278682 DOI: 10.1016/j.biomaterials.2020.120562] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
Cancer phototherapy has attracted increasing attention for its promising effectiveness and relative non-invasiveness. Over the past years, tremendous efforts have been made to develop better phototherapy strategies with various nano delivery systems. This review introduces cancer phototherapy strategies based on tumor blood vessels for improved therapeutic outcomes from the angle of direct tumor destruction and improved delivery process assisted with nano delivery designs. Latest directions and ideas of cancer phototherapy with translation potential are also discussed. Focusing on the double role of tumor vessels not only as an anti-tumor target but also as part of the delivery process, we highlight the crosstalk between photo-induced extensive effects and the complicated drug delivery process. Due to the heterogeneity of tumors, deeper investigations about the interconnection between tumor vessels and cancer phototherapy remain to be carried out. More delicate and intelligent nano delivery systems are expected to help realize the full potential of this therapeutic strategy.
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Affiliation(s)
- Shan Yang
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, Department of Pharmaceutics, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Chen Chen
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, Department of Pharmaceutics, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Yue Qiu
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, Department of Pharmaceutics, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Cheng Xu
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, Department of Pharmaceutics, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China
| | - Jing Yao
- State Key Laboratory of Natural Medicines and Jiangsu Key Laboratory of Druggability of Biopharmaceuticals, Department of Pharmaceutics, China Pharmaceutical University, 639 Longmian Avenue, Nanjing, 211198, China.
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6
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Canto MI, Trindade AJ, Abrams J, Rosenblum M, Dumot J, Chak A, Iyer P, Diehl D, Khara HS, Corbett FS, McKinley M, Shin EJ, Waxman I, Infantolino A, Tofani C, Samarasena J, Chang K, Wang B, Goldblum J, Voltaggio L, Montgomery E, Lightdale CJ, Shaheen NJ. Multifocal Cryoballoon Ablation for Eradication of Barrett's Esophagus-Related Neoplasia: A Prospective Multicenter Clinical Trial. Am J Gastroenterol 2020; 115:1879-1890. [PMID: 33009064 DOI: 10.14309/ajg.0000000000000822] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION:
Ablation of Barrett's esophagus (BE) is the preferred approach for the treatment of neoplasia without visible lesions. Limited data on cryoballoon ablation (CBA) suggest its potential clinical utility. We evaluated the safety and efficacy of CBA in a multicenter study of patients with neoplastic BE.
METHODS:
In a prospective clinical trial, 11 academic and community centers recruited consecutive patients with BE of 1–6 cm length and low-grade dysplasia, high-grade dysplasia (HGD), or intramucosal adenocarcinoma (ImCA) confirmed by central pathology. Patients with symptomatic pre-existing strictures or visible BE lesions had dilation or endoscopic mucosal resection (EMR), respectively, before enrollment. A nitrous oxide cryoballoon focal ablation system was used to treat all visible columnar mucosa in up to 5 sessions. Study end points included complete eradication of all dysplasia (CE-D) and intestinal metaplasia (CE-IM) at 1 year.
RESULTS:
One hundred twenty patients with BE with ImCA (20%), HGD (56%), or low-grade dysplasia (23%) were enrolled. In the intention-to-treat analysis, the CE-D and CE-IM rates were 76% and 72%, respectively. In the per-protocol analysis (94 patients), the CE-D and CE-IM rates were 97% and 91%, respectively. Postablation pain was mild and short lived. Fifteen subjects (12.5%) developed strictures requiring dilation. One patient (0.8%) with HGD progressed to ImCA, which was successfully treated with EMR. Another patient (0.8%) developed gastrointestinal bleeding associated with clopidogrel use. One patient (0.8%) had buried BE with HGD in 1 biopsy, not confirmed by subsequent EMR.
DISCUSSION:
In patients with neoplastic BE, CBA was safe and effective. Head-to-head comparisons between CBA and other ablation modalities are warranted (clinicaltrials.gov registration NCT02514525).
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Affiliation(s)
- Marcia Irene Canto
- Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Arvind J. Trindade
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Julian Abrams
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Michael Rosenblum
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - John Dumot
- Division of Gastroenterology at University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amitabh Chak
- Division of Gastroenterology at University Hospitals of Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prasad Iyer
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Diehl
- Division of Gastroenterology, Geisinger Medical Center, Danby Pennsylvania, USA
| | - Harshit S. Khara
- Division of Gastroenterology, Geisinger Medical Center, Danby Pennsylvania, USA
| | | | - Matthew McKinley
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Eun Ji Shin
- Department of Medicine (Gastroenterology), Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Irving Waxman
- Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Anthony Infantolino
- Division of Gastroenterology, Jefferson Medical Center, Philadelphia, Pennsylvania, USA
| | - Christina Tofani
- Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jason Samarasena
- Division of Gastroenterology, University of California Irvine Medical Center, Irvine, California, USA
| | - Kenneth Chang
- Division of Gastroenterology, University of California Irvine Medical Center, Irvine, California, USA
| | - Bingkai Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - John Goldblum
- Department of Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Lysandra Voltaggio
- Department ofPathology, Johns Hopkins Medical Institutions Baltimore Maryland, USA
| | - Elizabeth Montgomery
- Department ofPathology, Johns Hopkins Medical Institutions Baltimore Maryland, USA
| | - Charles J. Lightdale
- Division of Gastroenterology at the Zucker School of Medicine of Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Nicholas J. Shaheen
- Division of Gastroenterology, University of North Carolina, Chapel Hill, North Carolina, USA
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de Souza LA, Passos LA, Mendel R, Ebigbo A, Probst A, Messmann H, Palm C, Papa JP. Assisting Barrett's esophagus identification using endoscopic data augmentation based on Generative Adversarial Networks. Comput Biol Med 2020; 126:104029. [PMID: 33059236 DOI: 10.1016/j.compbiomed.2020.104029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Barrett's esophagus figured a swift rise in the number of cases in the past years. Although traditional diagnosis methods offered a vital role in early-stage treatment, they are generally time- and resource-consuming. In this context, computer-aided approaches for automatic diagnosis emerged in the literature since early detection is intrinsically related to remission probabilities. However, they still suffer from drawbacks because of the lack of available data for machine learning purposes, thus implying reduced recognition rates. This work introduces Generative Adversarial Networks to generate high-quality endoscopic images, thereby identifying Barrett's esophagus and adenocarcinoma more precisely. Further, Convolution Neural Networks are used for feature extraction and classification purposes. The proposed approach is validated over two datasets of endoscopic images, with the experiments conducted over the full and patch-split images. The application of Deep Convolutional Generative Adversarial Networks for the data augmentation step and LeNet-5 and AlexNet for the classification step allowed us to validate the proposed methodology over an extensive set of datasets (based on original and augmented sets), reaching results of 90% of accuracy for the patch-based approach and 85% for the image-based approach. Both results are based on augmented datasets and are statistically different from the ones obtained in the original datasets of the same kind. Moreover, the impact of data augmentation was evaluated in the context of image description and classification, and the results obtained using synthetic images outperformed the ones over the original datasets, as well as other recent approaches from the literature. Such results suggest promising insights related to the importance of proper data for the accurate classification concerning computer-assisted Barrett's esophagus and adenocarcinoma detection.
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Affiliation(s)
- Luis A de Souza
- Department of Computing, São Carlos Federal University, UFSCar, Brazil; Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Leandro A Passos
- Department of Computing, São Paulo State University, UNESP, Brazil
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Health Sciences and Technology (RCHST), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - João P Papa
- Department of Computing, São Paulo State University, UNESP, Brazil.
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8
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Morreale GC, Sinagra E, Vitello A, Shahini E, Shahini E, Maida M. Emerging artificial intelligence applications in gastroenterology: A review of the literature. Artif Intell Gastrointest Endosc 2020; 1:6-18. [DOI: 10.37126/aige.v1.i1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) allows machines to provide disruptive value in several industries and applications. Applications of AI techniques, specifically machine learning and more recently deep learning, are arising in gastroenterology. Computer-aided diagnosis for upper gastrointestinal endoscopy has growing attention for automated and accurate identification of dysplasia in Barrett’s esophagus, as well as for the detection of early gastric cancers (GCs), therefore preventing esophageal and gastric malignancies. Besides, convoluted neural network technology can accurately assess Helicobacter pylori (H. pylori) infection during standard endoscopy without the need for biopsies, thus, reducing gastric cancer risk. AI can potentially be applied during colonoscopy to automatically discover colorectal polyps and differentiate between neoplastic and non-neoplastic ones, with the possible ability to improve adenoma detection rate, which changes broadly among endoscopists performing screening colonoscopies. In addition, AI permits to establish the feasibility of curative endoscopic resection of large colonic lesions based on the pit pattern characteristics. The aim of this review is to analyze current evidence from the literature, supporting recent technologies of AI both in upper and lower gastrointestinal diseases, including Barrett's esophagus, GC, H. pylori infection, colonic polyps and colon cancer.
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Affiliation(s)
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia- M. Raimondi Hospital, Caltanissetta 93100, Italy
| | - Endrit Shahini
- Gastroenterology and Endoscopy Unit, Istituto di Candiolo, FPO-IRCCS, Candiolo (Torino) 93100, Italy
| | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia- M. Raimondi Hospital, Caltanissetta 93100, Italy
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9
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Morreale GC, Sinagra E, Vitello A, Shahini E, Shahini E, Maida M. Emerging artificia intelligence applications in gastroenterology: A review of the literature. Artif Intell Gastrointest Endosc 2020. [DOI: 10.37126/wjem.v1.i1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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10
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Malacarne MC, Banfi S, Caruso E. In vitro photodynamic treatment of cancer cells induced by aza-BODIPYs. Photochem Photobiol Sci 2020; 19:790-799. [PMID: 33856674 DOI: 10.1039/d0pp00026d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/17/2020] [Indexed: 11/21/2022]
Abstract
Two aza-BODIPY photosensitizes (PSs, compounds 7 and 8), featuring an iodine atom on each pyrrolic unit of their structure, were synthesized in fairly good yields starting from commercial products and tested in vitro on two human cancer cell lines (HCT116 and SKOV3) to assess their photodynamic efficacy. After treating the cell cultures with variable concentrations of 7 or 8 and incubating for the desired incubation time, the cells were irradiated for two hours with a red-light emitting diode (LED) device; afterwards the extent of cell death was determined by MTT assay. Besides the killing effect, the new PSs were also studied to determine further parameters related to photodynamic efficacy, such as the resistance towards photobleaching, the rate of singlet oxygen production, the fluorescence quantum yields, the cellular uptake and the localization inside the cells and, finally, flow cytometric analysis for apoptosis. Considering the results as a whole, these aza-BODIPYs can be considered to be promising photosensitizers because of their IC50 values being below micromolar concentrations and for more rather interesting features. Actually, these molecules have proved to be: (a) quite stable towards photobleaching; (b) good producers of singlet oxygen and (c) highly penetrating the cells with a wide distribution in the cytosol. Furthermore, in accordance with the good rate of singlet oxygen production, the apoptotic cells reach 30% and this allows us to assume a low inflammatory effect of the in vivo PDT treatment; thus a possible in vivo application of these aza-BODIPYs might be plausible.
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Affiliation(s)
- Miryam Chiara Malacarne
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Via J.H. Dunant 3, 21100, Varese, VA, Italy
| | - Stefano Banfi
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Via J.H. Dunant 3, 21100, Varese, VA, Italy
| | - Enrico Caruso
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Via J.H. Dunant 3, 21100, Varese, VA, Italy.
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11
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Franklin J, Jankowski J. Recent advances in understanding and preventing oesophageal cancer. F1000Res 2020; 9. [PMID: 32399195 PMCID: PMC7194479 DOI: 10.12688/f1000research.21971.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/24/2022] Open
Abstract
Oesophageal cancer is a common cancer that continues to have a poor survival. This is largely in part due to its late diagnosis and early metastatic spread. Currently, screening is limited to patients with multiple risk factors via a relatively invasive technique. However, there is a large proportion of patients diagnosed with oesophageal cancer who have not been screened. This has warranted the development of new screening techniques that could be implemented more widely and lead to earlier identification and subsequently improvements in survival rates. This article also explores progress in the surveillance of Barrett’s oesophagus, a pre-malignant condition for the development of oesophageal adenocarcinoma. In recent years, advances in early endoscopic intervention have meant that more patients are considered at an earlier stage for potentially curative treatment.
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Affiliation(s)
- James Franklin
- Gastroenterology and Endoscopy Department, Kings Mill Hospital NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, NG17 4JL, UK
| | - Janusz Jankowski
- Gastroenterology and Endoscopy Department, Kings Mill Hospital NHS Foundation Trust, Sutton-in-Ashfield, Nottinghamshire, NG17 4JL, UK
- University of Liverpool, Liverpool, UK
- University of Roehampton, London, UK
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12
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Ahmed O, Ajani JA, Lee JH. Endoscopic management of esophageal cancer. World J Gastrointest Oncol 2019; 11:830-841. [PMID: 31662822 PMCID: PMC6815921 DOI: 10.4251/wjgo.v11.i10.830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/29/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer (EC) generally consists of squamous cell carcinoma (which arise from squamous epithelium) and adenocarcinoma (which arise from columnar epithelium). Due to the increased recognition of risk factors associated with EC and the development of screening programs, there has been an increase in the diagnosis of early EC. Early EC is amenable to curative therapy by endoscopy, which can be performed by either endoscopic resection or endoscopic ablation. Endoscopic resection consists of either endoscopic mucosal resection (preferred in cases of adenocarcinoma) or endoscopic submucosal dissection (preferred in cases of squamous cell carcinoma). Endoscopic ablation can be performed by either radiofrequency ablation, cryotherapy, argon plasma coagulation or photodynamic therapy, amongst others. Endoscopy can also assist in the management of complications post-esophageal surgery, such as anastomotic leaks and perforations. Finally, there is a growing role for endoscopy to manage end-of-life palliative symptoms, especially dysphagia. The growing use of esophageal stents, debulking therapy and dilation can assist in improving a patient’s quality of life. In this review, we examine the multiple roles of endoscopy in the management of patients with EC.
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Affiliation(s)
- Osman Ahmed
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jaffer A Ajani
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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13
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Passos LA, de Souza Jr. LA, Mendel R, Ebigbo A, Probst A, Messmann H, Palm C, Papa JP. Barrett’s esophagus analysis using infinity Restricted Boltzmann Machines. JOURNAL OF VISUAL COMMUNICATION AND IMAGE REPRESENTATION 2019; 59:475-485. [DOI: 10.1016/j.jvcir.2019.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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14
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de Souza LA, Palm C, Mendel R, Hook C, Ebigbo A, Probst A, Messmann H, Weber S, Papa JP. A survey on Barrett's esophagus analysis using machine learning. Comput Biol Med 2018; 96:203-213. [PMID: 29626734 DOI: 10.1016/j.compbiomed.2018.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/15/2022]
Abstract
This work presents a systematic review concerning recent studies and technologies of machine learning for Barrett's esophagus (BE) diagnosis and treatment. The use of artificial intelligence is a brand new and promising way to evaluate such disease. We compile some works published at some well-established databases, such as Science Direct, IEEEXplore, PubMed, Plos One, Multidisciplinary Digital Publishing Institute (MDPI), Association for Computing Machinery (ACM), Springer, and Hindawi Publishing Corporation. Each selected work has been analyzed to present its objective, methodology, and results. The BE progression to dysplasia or adenocarcinoma shows a complex pattern to be detected during endoscopic surveillance. Therefore, it is valuable to assist its diagnosis and automatic identification using computer analysis. The evaluation of the BE dysplasia can be performed through manual or automated segmentation through machine learning techniques. Finally, in this survey, we reviewed recent studies focused on the automatic detection of the neoplastic region for classification purposes using machine learning methods.
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Affiliation(s)
- Luis A de Souza
- Department of Computing, São Paulo State University, UNESP, Brazil; Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany; Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Germany
| | - Robert Mendel
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | - Christian Hook
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Germany
| | | | | | | | - Silke Weber
- Department of Otorhinolaryngology, São Paulo State University, Brazil
| | - João P Papa
- Department of Computing, São Paulo State University, UNESP, Brazil.
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15
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Saxena N, Inadomi JM. Effectiveness and Cost-Effectiveness of Endoscopic Screening and Surveillance. Gastrointest Endosc Clin N Am 2017; 27:397-421. [PMID: 28577764 DOI: 10.1016/j.giec.2017.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Guidelines for the screening and surveillance of Barrett's esophagus continue to evolve as the incidence of esophageal adenocarcinoma increases, identification of individuals at highest risk for cancer improves, and management of dysplasia evolves. This article reviews related studies and economic analyses. Advances in diagnosis offer promising strategies to help focus screening efforts on those individuals who are most likely to develop esophageal adenocarcinoma.
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Affiliation(s)
- Nina Saxena
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Box 356424, Seattle, WA 98195, USA
| | - John M Inadomi
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Box 356424, Seattle, WA 98195, USA.
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16
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Belghazi K, Bergman J, Pouw RE. Endoscopic Resection and Radiofrequency Ablation for Early Esophageal Neoplasia. Dig Dis 2016; 34:469-75. [PMID: 27333327 PMCID: PMC5296892 DOI: 10.1159/000445221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In the last few decades, endoscopic treatment of early neoplastic lesions in the esophagus has established itself as a valid and less invasive alternative to surgical resection. Endoscopic resection (ER) is the cornerstone of endoscopic therapy. Next to the curative potential of ER, by removing neoplastic lesions, ER may also serve as a diagnostic tool. The relatively large tissue specimens obtained with ER enable accurate histological staging of a lesion, allowing for optimal decision-making for further patient management. ER was pioneered in Japan, mainly for the resection of gastric lesions and squamous esophageal neoplasia, and also Western countries have been increasingly implementing ER in the treatment of early gastroesophageal neoplasia, mostly associated with Barrett's esophagus (BE). In BE, however, there is still a risk of metachronous lesions in the remainder of the Barrett's after focal ER. Additional treatment of all Barrett's mucosa is therefore advised. Currently, the most effective method for this is by using radiofrequency ablation (RFA). This review will provide an overview of indications for ER and RFA. Key Messages and Conclusions: Endoscopic management of early esophageal neoplasia is a safe and valid alternative to surgery and is nowadays the treatment of choice. ER is the mainstay of endoscopic management of early esophageal neoplasia since it allows for removal of neoplastic lesions and provides a large tissue specimen for histological evaluation. In case of early neoplasia in BE, focal ER should be complemented by eradication of the remaining Barrett's mucosa. RFA has proven to be a safe and effective modality to achieve complete eradication of Barrett's mucosa.
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Affiliation(s)
| | | | - Roos E. Pouw
- *Roos E. Pouw, MD, PhD, Department of Gastroenterology and Hepatology Academic Medical Center Meibergdreef 9, NL-1105 AZ Amsterdam (The Netherlands) E-Mail
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17
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Das A, Callenberg KM, Styn MA, Jackson SA. Endoscopic ablation is a cost-effective cancer preventative therapy in patients with Barrett's esophagus who have elevated genomic instability. Endosc Int Open 2016; 4:E549-59. [PMID: 27227114 PMCID: PMC4874803 DOI: 10.1055/s-0042-103415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/08/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The surveillance of patients with nondysplastic Barrett's esophagus (NDBE) has a high cost and is of limited effectiveness in preventing esophageal adenocarcinoma (EAC). Ablation for NDBE remains expensive and controversial. Biomarkers of genomic instability have shown promise in identifying patients with NDBE at high risk for progression to EAC. Here, we evaluate the cost-effectiveness of using such biomarkers to stratify patients with NDBE by risk for EAC and, subsequently, the cost-effectiveness of ablative therapy. METHODS A Markov decision tree was used to evaluate four strategies in a hypothetical cohort of 50-year old patients with NDBE over their lifetime: strategy I, natural history without surveillance; strategy II, surveillance per current guidelines; strategy III, ablation for all patients; strategy IV, risk stratification with use of a biomarker panel to assess genomic instability (i. e., mutational load [ML]). Patients with no ML underwent minimal surveillance, patients with low ML underwent standard surveillance, and patients with high ML underwent ablation. The incremental cost-effectiveness ratio (ICER) and incremental net health benefit (INHB) were assessed. RESULTS Strategy IV provided the best values for quality-adjusted life years (QALYs), ICER, and INHB in comparison with strategies II and III. RESULTS were robust in sensitivity analysis. In a Monte Carlo analysis, the relative risk for the development of cancer in the patients managed with strategy IV was decreased. Critical determinants of strategy IV cost-effectiveness were the complete response rate, cost of ablation, and surveillance interval in patients with no ML. CONCLUSION The use of ML to stratify patients with NDBE by risk was the most cost-effective strategy for preventive EAC treatment. Targeting ablation toward patients with high ML presents an opportunity for a paradigm shift in the management of NDBE.
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Affiliation(s)
- Ananya Das
- Arizona Center for Digestive Health, Gilbert, Arizona, USA,Corresponding author Ananya Das, MDF Arizona Center for Digestive Health2680 South Valvista Drive, Suite #116Gilbert, AZ 85295USA+1-412-224-6110
| | - Keith M. Callenberg
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Interpace Diagnostics Corporation (formerly RedPath Integrated Pathology), Pittsburgh, Pennsylvania, USA
| | - Mindi A. Styn
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,Interpace Diagnostics Corporation (formerly RedPath Integrated Pathology), Pittsburgh, Pennsylvania, USA
| | - Sara A. Jackson
- Interpace Diagnostics Corporation (formerly RedPath Integrated Pathology), Pittsburgh, Pennsylvania, USA
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18
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Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BLAM, Schumacher B, Rembacken B, Meining A, Messmann H, Schoon EJ, Gossner L, Mannath J, Seldenrijk CA, Visser M, Lerut T, Seewald S, ten Kate FJ, Ell C, Neuhaus H, Bergman JJGHM. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut 2016; 65:555-62. [PMID: 25731874 DOI: 10.1136/gutjnl-2015-309298] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/07/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Focal endoscopic resection (ER) followed by radiofrequency ablation (RFA) safely and effectively eradicates Barrett's oesophagus (BO) containing high-grade dysplasia (HGD) and/or early cancer (EC) in smaller studies with limited follow-up. Herein, we report long-term outcomes of combined ER and RFA for BO (HGD and/or EC) from a single-arm multicentre interventional study. DESIGN In 13 European centres, patients with BO ≤ 12 cm with HGD and/or EC on 2 separate endoscopies were eligible for inclusion. Visible lesions (<2 cm length; <50% circumference) were removed with ER, followed by serial RFA every 3 months (max 5 sessions). Follow-up endoscopy was scheduled at 6 months after the first negative post-treatment endoscopic control and annually thereafter. OUTCOMES complete eradication of neoplasia (CE-neo) and intestinal metaplasia (CE-IM); durability of CE-neo and CE-IM (once achieved) during follow-up. Biopsy and resection specimens underwent centralised pathology review. RESULTS 132 patients with median BO length C3M6 were included. After entry-ER in 119 patients (90%) and a median of 3 RFA (IQR 3-4) treatments, CE-neo was achieved in 121/132 (92%) and CE-IM in 115/132 patients (87%), per intention-to-treat analysis. Per-protocol analysis, CE-neo and CE-IM were achieved in 98% and 93%, respectively. After a median of 27 months following the first negative post-treatment endoscopic control, neoplasia and IM recurred in 4% and 8%, respectively. Mild-to-moderate adverse events occurred in 25 patients (19%); all managed conservatively or endoscopically. CONCLUSIONS In patients with early Barrett's neoplasia, intensive multimodality endotherapy consisting of ER combined with RFA is safe and highly effective, and the treatment effect appears to be durable during mid-term follow-up. TRIAL REGISTRATION NUMBER NTR 1211, http://www.trialregister.nl.
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Affiliation(s)
- K Nadine Phoa
- Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands
| | - Roos E Pouw
- Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands
| | - Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium
| | - Oliver Pech
- Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Krish Ragunath
- Department of Gastroenterology, Queens Medical Centre, Nottingham, UK
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Brigitte Schumacher
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Bjorn Rembacken
- Department of Gastroenterology, The General Infirmary at Leeds, Leeds, UK
| | - Alexander Meining
- Department of Gastroenterology, Klinikum rechts der Isar, Munich, Germany
| | - Helmut Messmann
- Department of Gastroenterology, Augsburg Hospital, Augsburg, Germany
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands
| | - Liebwin Gossner
- Department of Internal Medicine II, Karlsruhe Hospital, Karlsruhe, Germany
| | - Jayan Mannath
- Department of Gastroenterology, Queens Medical Centre, Nottingham, UK
| | - C A Seldenrijk
- Department of Pathology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mike Visser
- Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands
| | - Toni Lerut
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Vlaams Brabant, Belgium
| | - Stefan Seewald
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fiebo J ten Kate
- Department of Pathology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands
| | - Christian Ell
- Department of Internal Medicine II, Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Centre-University of Amsterdam, Amsterdam, the Netherlands
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Management of Barrett's esophagus: Screening to newer treatments. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Thoguluva Chandrasekar V, Vennalaganti P, Sharma P. Management of Barrett's esophagus: From screening to newer treatments. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2016; 81:91-102. [PMID: 26964773 DOI: 10.1016/j.rgmx.2015.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/15/2015] [Indexed: 02/07/2023]
Abstract
Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.
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Affiliation(s)
| | - P Vennalaganti
- Department of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas city, Missouri, EE. UU
| | - P Sharma
- Department of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas city, Missouri, EE. UU..
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21
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David WJ, Qumseya BJ, Qumsiyeh Y, Heckman MG, Diehl NN, Wallace MB, Raimondo M, Woodward TA, Wolfsen HC. Comparison of endoscopic treatment modalities for Barrett's neoplasia. Gastrointest Endosc 2015; 82:793-803.e3. [PMID: 26071064 DOI: 10.1016/j.gie.2015.03.1979] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/27/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND There are few data comparing endoscopic treatment outcomes for Barrett's esophagus (BE). OBJECTIVE To compare treatment outcomes in BE patients treated with radiofrequency ablation (RFA), RFA after EMR, and porfimer sodium photodynamic therapy (Ps-PDT). DESIGN Retrospective, observational study. SETTING Single tertiary center between 2001 and 2013. PATIENTS A total of 342 BE patients treated with RFA (n = 119), EMR+RFA (n = 98), and Ps-PDT (n = 125). MAIN OUTCOME MEASUREMENTS Rates of complete remission of intestinal metaplasia (CRIM), BE recurrence, and adverse events. RESULTS Baseline BE high-grade dysplasia (HGD) and adenocarcinoma were more common in the Ps-PDT group (89%) compared with the EMR-RFA (70%) and RFA (37%) groups. At a median follow-up of 14.2 months, 173 patients (50.6%) achieved CRIM. CRIM was significantly more common in Ps-PDT patients compared with RFA (P < .001) and EMR-RFA (P < .001) patients on multivariable analysis. In patients who achieved CRIM, the rates of subsequent BE recurrence were relatively similar among the 3 groups. Although the rates of bleeding were similar, strictures were less common in RFA patients (2.4%) compared with EMR-RFA (13.3%, P = .001) and Ps-PDT (10.4%, P =.043) patients. CONCLUSION This study of endoscopic treatment for Barrett's dysplasia and neoplasia found that complete remission was achieved more often and more rapidly after Ps-PDT with similar disease recurrence rates compared with EMR or RFA. Adverse events were more common after EMR and Ps-PDT. Further studies are required to determine which ablation and resection techniques are ideally suited for each BE patient.
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Affiliation(s)
- Waseem J David
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Bashar J Qumseya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; Florida State University, Archbold Medical Group, Thomasville, Georgia, USA
| | - Yazen Qumsiyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA; University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Timothy A Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Herbert C Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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22
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Milashka M, Calomme A, Van Laethem JL, Blero D, Eisendrath P, Le Moine O, Devière J. Sixteen-year follow-up of Barrett's esophagus, endoscopically treated with argon plasma coagulation. United European Gastroenterol J 2014; 2:367-73. [PMID: 25360314 DOI: 10.1177/2050640614549095] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/29/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The thermal destruction of non-dysplastic Barrett's esophagus (BE) and its replacement by squamous epithelium is an attractive, but unproven strategy to avoid further development of dysplasia or cancer. The goal of this study was to estimate the persistence of restoration of squamous epithelium and the risk of cancer in BE that was eradicated using argon plasma coagulation (APC) in the absence of high-grade dysplasia, 16 years after its application. DESIGN We followed 32 patients with BE who underwent eradication of metaplastic epithelium using APC, up to 16 years later. RESULTS At the end of the initial treatment, 25 of 32 patients (78%) had complete endoscopic eradication, there was partial squamous re-epithelialization in four patients (13%) and it was absent in three patients (9%). We observed buried metaplastic glands under new squamous epithelium in 6 of the 25 patients who had complete endoscopic eradication. At follow-up, sustained complete endoscopic eradication was observed in 16 of 32 patients (50%), partial eradication in 11 of 32 patients (35%); there were two patients (6%) lost to follow-up and three patients (9%) developed esophageal adenocarcinoma. Two of the latest cases arose from the buried glands under neosquamous epithelium after complete eradication and one arose from a small remaining Barrett's segment. CONCLUSIONS We observed long-term re-epithelialization in the majority of patients who had previously had complete eradication of Barrett's esophagus. This did not provide protection against cancer development, as the incidence of cancers arising from buried glands or from residual Barrett's esophagus was similar to that observed in patients undergoing no specific treatment.
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Affiliation(s)
- Mariana Milashka
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Annabelle Calomme
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Luc Van Laethem
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Blero
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Le Moine
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium
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23
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Qumseya B, David W, Woodward TA, Raimondo M, Wallace MB, Wolfsen HC, Lukens FJ. Safety of esophageal EMR in elderly patients. Gastrointest Endosc 2014; 80:586-591. [PMID: 24703086 DOI: 10.1016/j.gie.2014.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/06/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND EMR is commonly used to remove suspicious esophageal lesions among patients with Barrett's esophagus (BE). BE primarily affects older patients. Yet, the safety profile of EMR in elderly patients has not been well-described. OBJECTIVE We aimed to study the safety profile of EMR in elderly patients compared with younger patients. DESIGN Retrospective, observational, descriptive study that used a prospective database. SETTING Tertiary-care referral center. PATIENTS A total of 136 patients who underwent esophageal EMR for BE. INTERVENTIONS EMR with/without ablative therapy. MAIN OUTCOME MEASUREMENTS The rate of adverse events, including bleeding, stricture formation, and perforation between elderly (aged ≥75 years) and younger (aged <75 years) patients. RESULTS We identified 136 patients who underwent esophageal EMR who were followed-up in our clinic. Of those, 40% (n = 55) were aged ≥75 years (elderly group) and 60% (n = 81) were aged <75 years (younger group). There was no difference in rate of stricture formation or early or delayed bleeding when we compared elderly patients to younger patients. None of the patients had esophageal perforation. On multivariable logistic regression analysis, controlling for patient sex, EMR technique, and underlying pathology, older age was not associated with increased odds of adverse events (OR 0.88; 95% confidence interval, 0.42-1.9; P = .75). LIMITATIONS Single-center experience. CONCLUSION Rates of adverse events from EMR appear to be similar in elderly patients compared with younger patients. Overall, esophageal EMR seems to offer an acceptable safety profile in elderly patients.
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Affiliation(s)
- Bashar Qumseya
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Waseem David
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Timothy A Woodward
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Massimo Raimondo
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Herbert C Wolfsen
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Frank J Lukens
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Ablative therapy for esophageal dysplasia and early malignancy: focus on RFA. BIOMED RESEARCH INTERNATIONAL 2014; 2014:642063. [PMID: 25140320 PMCID: PMC4129136 DOI: 10.1155/2014/642063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/07/2014] [Indexed: 02/07/2023]
Abstract
Ablative therapies have been utilized with increasing frequency for the treatment of Barrett's esophagus with and without dysplasia. Multiple modalities are available for topical ablation of the esophagus, but radiofrequency ablation (RFA) remains the most commonly used. There have been significant advances in technique since the introduction of RFA. The aim of this paper is to review the indications, techniques, outcomes, and most common complications following esophageal ablation with RFA.
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25
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Almond LM, Hodson J, Barr H. Meta-analysis of endoscopic therapy for low-grade dysplasia in Barrett's oesophagus. Br J Surg 2014; 101:1187-95. [DOI: 10.1002/bjs.9573] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/25/2013] [Accepted: 04/24/2014] [Indexed: 12/20/2022]
Abstract
Abstract
Background
The optimal management of patients with Barrett's-associated low-grade dysplasia (LGD) is unclear. The objective of this study was to identify systematically all reports of endoscopic treatment of LGD, and to assess outcomes in terms of disease progression, eradication of dysplasia and intestinal metaplasia, and complication rates.
Methods
A systematic review of articles reporting endoscopic treatment of LGD was conducted in accordance with PRISMA guidelines. MEDLINE and Embase databases were searched to identify the relevant literature. Rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D) were reported. The pooled incidence of progression to cancer was calculated following endoscopic therapy.
Results
Thirty-seven studies met the inclusion criteria, reporting outcomes of endoscopic therapy for 521 patients with LGD. The pooled incidence of progression to cancer was 3·90 (95 per cent confidence interval (c.i.) 1·27 to 9·10) per 1000 patient-years. CE-IM and CE-D were achieved in 67·8 (95 per cent c.i. 50·2 to 81·5) and 88·9 (83·9 to 92·5) per cent of patients respectively. The commonest adverse event was stricture formation.
Conclusion
Reports of endoscopic therapy were heterogeneous and follow-up periods were short. There is a high likelihood of historical overdiagnosis of LGD. Endoscopic therapy, particularly radiofrequency ablation, appears safe and effective at eradicating LGD, but does not eliminate the risk of progression to cancer.
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Affiliation(s)
- L M Almond
- Department of Upper Gastrointestinal Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - J Hodson
- Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Barr
- Department of Upper Gastrointestinal Surgery, Gloucestershire Royal Hospital, Gloucester, UK
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26
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Jagadesham VP, Kelty CJ. Low grade dysplasia in Barrett’s esophagus: Should we worry? World J Gastrointest Pathophysiol 2014; 5:91-99. [PMID: 24891980 PMCID: PMC4025077 DOI: 10.4291/wjgp.v5.i2.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/11/2014] [Accepted: 04/09/2014] [Indexed: 02/07/2023] Open
Abstract
The optimal management for low-grade dysplasia (LGD) in Barrett’s esophagus is unclear. In this article the importance of LGD is discussed, including the significant risk of progression to esophageal adenocarcinoma. Endoscopic surveillance is a management option but is plagued by sampling error and issues of suboptimal endoscopy. Furthermore endoscopic surveillance has not been demonstrated to be cost-effective or to reduce cancer mortality. The emergence of endoluminal therapy over the past decade has resulted in a paradigm shift in the management of LGD. Ablative therapy, including radiofrequency ablation, has demonstrated promising results in the management of LGD with regards to safety, cost-effectiveness, durability and reduction in cancer risk. It is, however, vital that a shared-decision making process occurs between the physician and the patient as to the preferred management of LGD. As such the management of LGD should be “individualised.”
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27
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Basavappa M, Weinberg A, Huang Q, Mashimo H. Markers suggest reduced malignant potential of subsquamous intestinal metaplasia compared with Barrett's esophagus. Dis Esophagus 2014; 27:262-6. [PMID: 23796148 DOI: 10.1111/dote.12087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal subsquamous intestinal metaplasia (SSIM) is frequently observed in patients with Barrett's esophagus (BE) and can also be found in patients after endoscopic ablative treatments for dysplastic BE. While these 'buried glands' appear identical to BE glands, features of SSIM and its malignant potency have yet to be fully elucidated. To determine differences in malignant potential between nondysplastic BE and SSIM, the Automated Cellular Imaging System was used to assess and compare changes in DNA content between SSIM and BE. Samples were further immunostained for Ki67 and Lgr5 to gauge general proliferative and possible stem cell features, respectively, in SSIM cells compared with BE glands. No significant differences were found between SSIM and BE with regards to DNA ploidy aberrance. However, significant differences were noted between SSIM and BE upon immunohistochemical analysis. SSIM was found to be negative for both Ki67 and Lgr5 while BE was positive for both markers. SSIM cells appear to be relatively quiescent and behave differently from BE, suggesting a reduced proclivity toward cancer progression.
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Affiliation(s)
- M Basavappa
- VA Boston Healthcare System, Boston, MA, USA
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Wu J, Pan YM, Wang TT, Gao DJ, Hu B. Endotherapy versus surgery for early neoplasia in Barrett's esophagus: a meta-analysis. Gastrointest Endosc 2014; 79:233-241.e2. [PMID: 24079410 DOI: 10.1016/j.gie.2013.08.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/04/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophagectomy is the conventional treatment for Barrett's esophagus with high-grade dysplasia and intramucosal cancer. Endotherapy is an alternative treatment. OBJECTIVE To compare the efficacy and safety of these 2 treatments. DESIGN PubMed, Web of Science, EMBASE, Cochrane Library and momentous meeting abstracts were searched. Studies comparing endotherapy with esophagectomy were included in the meta-analysis. Pooling was conducted in a random-effects model. SETTING Tertiary-care facility. PATIENTS Seven studies involving 870 patients were included. INTERVENTION Endotherapy and esophagectomy. MAIN OUTCOME MEASUREMENTS Neoplasia remission rate, neoplasia recurrence rate, overall survival rate, neoplasia-related death, and major adverse events. RESULTS Meta-analysis showed that there was no significant difference between endotherapy and esophagectomy in the neoplasia remission rate (relative risk [RR] 0.96; 95% CI, 0.91-1.01); overall survival rate at 1 year (RR 0.99; 95% CI, 0.94-1.03), 3 years (RR 1.03; 95% CI, 0.96-1.10), and 5 years (RR 1.00; 95% CI, 0.93-1.06); and neoplasia-related mortality (risk difference [RD] 0; 95% CI, -0.02 to 0.01). Endotherapy was associated with a higher neoplasia recurrence rate (RR 9.50; 95% CI, 3.26-27.75) and fewer major adverse events (RR 0.38; 95% CI, 0.20-0.73). LIMITATIONS Relatively small number of retrospective studies available, different types of endoscopic treatments were used. CONCLUSION Endotherapy and esophagectomy show similar efficacy except in the neoplasia recurrence rate, which is higher after endotherapy. Prospective, randomized, controlled trials are needed to confirm these results.
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Affiliation(s)
- Jun Wu
- Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China
| | - Ya-min Pan
- Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China
| | - Tian-tian Wang
- Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China
| | - Dao-jian Gao
- Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China
| | - Bing Hu
- Department of Endoscopy, Eastern Hepatobiliary Hospital, The Second Military Medical University, Shanghai, China
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29
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Wong RF, Bhutani MS. Therapeutic endoscopy and endoscopic ultrasound for gastrointestinal malignancies. Expert Rev Anticancer Ther 2014; 5:705-18. [PMID: 16111470 DOI: 10.1586/14737140.5.4.705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gastrointestinal endoscopy and endoscopic ultrasound not only provide strategies to diagnose and stage malignancy, but also to administer palliative and definitive care. Options for anticancer therapy include endoscopic mucosal resection, photodynamic therapy, thermal therapy, self-expanding metal stents and recently, endoscopic ultrasound-guided therapy, such as intratumoral injection. This review summarizes the available endoscopic techniques with a discussion of indications and recent clinical data pertaining to gastrointestinal malignancy. This review will inform the reader of emerging treatment options and stress the importance of incorporating gastroenterologists into the multidisciplinary approach in the management of gastrointestinal cancers.
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Affiliation(s)
- Robert F Wong
- Division of Gastroenterology, Department of Internal Medicine, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
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30
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Bronner MP. Barrett's Esophagus. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2014. [DOI: 10.7704/kjhugr.2014.14.3.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mary P. Bronner
- Division of Anatomic Pathology & Molecular Oncology, University of Utah and ARUP Laboratories, Huntsman Cancer Institute, Salt Lake City, UT, USA
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31
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Phoa KN, Pouw RE, van Vilsteren FGI, Sondermeijer CMT, Ten Kate FJW, Visser M, Meijer SL, van Berge Henegouwen MI, Weusten BLAM, Schoon EJ, Mallant-Hent RC, Bergman JJGHM. Remission of Barrett's esophagus with early neoplasia 5 years after radiofrequency ablation with endoscopic resection: a Netherlands cohort study. Gastroenterology 2013; 145:96-104. [PMID: 23542068 DOI: 10.1053/j.gastro.2013.03.046] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/20/2013] [Accepted: 03/21/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Radiofrequency ablation (RFA), with or without endoscopic resection effectively eradicates Barrett's esophagus (BE) containing high-grade intraepithelial neoplasia and/or early-stage cancer. We followed patients who received RFA for BE containing high-grade intraepithelial neoplasia and/or early-stage cancer for 5 years to determine the durability of treatment response. METHODS We followed 54 patients with BE (2-12 cm), previously enrolled in 4 consecutive cohort studies in which they underwent focal endoscopic resection in case of visible lesions (n = 40 [72%]), followed by serial RFA every 3 months. Patients underwent high-resolution endoscopy with narrow-band imaging at 6 and 12 months after treatment and then annually for 5 years (median, 61 months; interquartile range, 53-65 months); random biopsy samples were collected from neosquamous epithelium and gastric cardia. After 5 years, endoscopic ultrasound and endoscopic resection of neosquamous epithelium were performed. Outcomes included sustained complete remission of neoplasia or intestinal metaplasia (IM), IM in gastric cardia, or buried glands in neosquamous epithelium. RESULTS After 5 years, Kaplan-Meier analysis showed sustained complete remission of neoplasia and intestinal metaplasia in 90% of patients; neoplasia recurred in 3 patients and was managed endoscopically. Focal IM in the cardia was found in 19 of 54 patients (35%), in 53 of 1143 gastric cardia biopsies (4.6%). The incidence of IM of the cardia did not increase over time; and IM was diagnosed based on only a single biopsy in 89% of patients. Buried glands were detected in 3 of 3543 neosquamous epithelium biopsies (0.08%, from 3 patients). No endoscopic resection samples had buried glands. CONCLUSIONS Among patients who have undergone RFA with or without endoscopic resection for neoplastic BE, 90% remain in remission at 5-year follow-up, with all recurrences managed endoscopically. This treatment approach is therefore an effective and durable alternative to esophagectomy; www.trialregister.nl number, NTR2938.
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Affiliation(s)
- K Nadine Phoa
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Roos E Pouw
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Fiebo J W Ten Kate
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mike Visser
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sybren L Meijer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bas L A M Weusten
- Department of Gastroenterology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
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Leggett CL, Gorospe EC, Wang KK. Endoscopic therapy for Barrett's esophagus and early esophageal adenocarcinoma. Gastroenterol Clin North Am 2013; 42:175-85. [PMID: 23452637 PMCID: PMC3815664 DOI: 10.1016/j.gtc.2012.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endoscopic therapy for Barrett's esophagus is feasible and likely to decrease the future risk of development of esophageal adenocarcinoma. The most commonly used therapy is radiofrequency ablation, which has been shown to produce reproducible superficial injury in the esophagus. Other thermal therapies include multipolar coagulation, argon plasma coagulation, and thermal laser therapy. The other end of the ablative spectrum includes cryotherapy, which involves freezing tissue to produce mucosal necrosis. Photodynamic therapy has been used to photochemically eliminate abnormal mucosa. Endoscopic therapy has been demonstrated to be effective in high-risk situations such as Barrett's esophagus with high-grade dysplasia.
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Affiliation(s)
- Cadman L Leggett
- Barrett's Esophagus Unit, Division of Gastroenterology & Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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33
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Evans JA, Early DS, Chandraskhara V, Chathadi KV, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jue TL, Pasha SF, Sharaf R, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2013; 77:328-34. [PMID: 23410694 DOI: 10.1016/j.gie.2012.10.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 02/08/2023]
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34
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Qumseya BJ, David W, Wolfsen HC. Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma. Clin Endosc 2013; 46:30-7. [PMID: 23423151 PMCID: PMC3572348 DOI: 10.5946/ce.2013.46.1.30] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 01/14/2023] Open
Abstract
This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting.
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Affiliation(s)
- Bashar J Qumseya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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35
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Liu JY, Liu BR. Minimally invasive treatments for Barrett's esophagus. Shijie Huaren Xiaohua Zazhi 2012; 20:3707-3712. [DOI: 10.11569/wcjd.v20.i36.3707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The incidence of esophageal adenocarcinoma has been rising in recent years. Barrett's esophagus (BE) is widely considered the precursor of invasive adenocarcinoma. High-grade dysplasia (HGD) in BE is the critical step before invasive esophageal adenocarcinoma. Currently, numerous minimally invasive treatments for BE with HGD are available; however, there have been no clear-cut guidelines for a large number of patients due to the individualization of therapy and the absence of long-term outcome evaluation. This review briefly summarizes currently available minimally invasive therapeutic modalities for BE and compares their therapeutic outcomes, with an aim to aid in the choice of the appropriate treatment.
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Abstract
Barrett esophagus surveillance programs and more liberal use of upper endoscopy are leading to the identification of more patients with high-grade dysplasia or early stage esophageal adenocarcinoma. These patients have several options for therapy, including endoscopic mucosal resection, vagal-sparing esophagectomy, and a combination of endoscopic resection and ablation. Factors that should be considered include the length of the Barrett segment, the presence of a nodule or ulcer within the Barrett segment, and the age and overall physical condition of the patient. Of particular importance will be the incidence of recurrent Barrett esophagus or cancer in the long-term in patients that were initially successfully treated endoscopically.
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Affiliation(s)
- Michael Hermansson
- Department of Surgery, Keck School of Medicine, The University of Southern California, Los Angeles, CA 90033, USA
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37
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Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, Chathadi KV, Decker GA, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha SF, Saltzman JR, Sharaf RN, Shergill A, Dominitz JA, Cash BD. The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 2012; 76:1087-94. [PMID: 23164510 DOI: 10.1016/j.gie.2012.08.004] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 02/06/2023]
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38
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Dua KS, Merrill J, Komorowski R. Neosquamous epithelium after ablation of Barrett's epithelium: cause for concern? Gastrointest Endosc 2012; 76:1082-3. [PMID: 23078943 DOI: 10.1016/j.gie.2012.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 12/11/2022]
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Chisholm JA, Mayne GC, Hussey DJ, Watson DI. Molecular biomarkers and ablative therapies for Barrett's esophagus. Expert Rev Gastroenterol Hepatol 2012; 6:567-81. [PMID: 23061708 DOI: 10.1586/egh.12.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Barrett's esophagus is the major risk factor for esophageal adenocarcinoma. Endoscopic interventions that ablate Barrett's esophagus mucosa lead to replacement with a new squamous (neosquamous) mucosa, but it can be difficult to achieve complete ablation. Knowing whether cancer is less likely to develop in neosquamous mucosa or residual Barrett's esophagus after ablation is critical for determining the efficacy of treatment. This issue can be informed by assessing biomarkers that are associated with an increased risk of progression to adenocarcinoma. Although there are few postablation biomarker studies, evidence suggests that neosquamous mucosa may have a reduced risk of adenocarcinoma in patients who have been treated for dysplasia or cancer, but some patients who do not have complete eradication of nondysplastic Barrett's esophagus may still be at risk. Biomarkers could be used to optimize endoscopic surveillance strategies following ablation, but this needs to be assessed by clinical studies and economic modeling.
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Affiliation(s)
- Jacob A Chisholm
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
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40
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Konda VJ, Waxman I. Low risk of prevalent submucosal invasive cancer among patients undergoing esophagectomy for treatment of Barrett's esophagus with high grade dysplasia. J Gastrointest Oncol 2012; 2:1-4. [PMID: 22811818 DOI: 10.3978/j.issn.2078-6891.2011.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/06/2011] [Indexed: 01/09/2023] Open
Affiliation(s)
- Vani Ja Konda
- Center for Endoscopic Research and Therapeutics (CERT), Section of Gastroenterology, Department of Medicine, The University of Chicago Medical Center, Chicago, IL
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41
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High-grade dysplasia and intramucosal adenocarcinoma in Barrett's esophagus: the role of endoscopic eradication therapy. Curr Opin Gastroenterol 2012; 28:354-61. [PMID: 22450896 PMCID: PMC4389732 DOI: 10.1097/mog.0b013e328352b78a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Endoscopic eradication therapy is considered a well tolerated and effective alternative to esophagectomy for a select patient population with high-grade Barrett's esophagus and intramucosal adenocarcinoma. This review highlights the available eradication techniques (resection and ablation) with emphasis on factors that influence the choice of therapy. RECENT FINDINGS Long-term follow-up of patients treated with endoscopic eradication therapies demonstrates high rates of complete remission of dysplasia and intestinal metaplasia with overall survival comparable to patients treated surgically. Cohort studies also report that recurrence following successful ablation occurs in a significant proportion of patients, making careful surveillance an indispensable component following successful endoscopic therapy. Endoscopic eradication therapy is also effective for the treatment of recurrent dysplasia and intestinal metaplasia. Ablative therapies may lead to buried metaplasia in a small proportion of patients. The long-term clinical implications of buried metaplasia are unclear. SUMMARY Patients undergoing endoscopic eradication therapy should be enrolled in a comprehensive surveillance and staging program that offers both resection and ablative techniques. Complete remission of dysplasia and intestinal metaplasia can be achieved in the vast majority of patients undergoing endoscopic therapy. Surveillance should continue after treatment with close monitoring for recurrent dysplasia.
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42
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Komanduri S. Endoscopic therapies for Barrett's-associated dysplasia: a new paradigm for a new decade. Expert Rev Gastroenterol Hepatol 2012; 6:291-300. [PMID: 22646252 DOI: 10.1586/egh.12.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The emergence of endoscopic therapies for Barrett's esophagus (BE)-associated dysplasia has significantly altered the management of this complex disease. Over the past decade, there has been a paradigm shift from that of pure surveillance to a more therapeutic approach in eradicating dysplastic BE. This strategy includes less invasive options than esophagectomy for high-grade dysplasia and early eradication of confirmed low-grade dysplasia. Although multiple modalities exist for endoscopic therapy, endoscopic mucosal resection coupled with radiofrequency ablation appears to be the most effective therapy, with minimal complications. Recent advances in endoscopic eradication therapies for dysplastic BE have fueled excitement for a significant weapon against the rising incidence of esophageal cancer.
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Affiliation(s)
- Sri Komanduri
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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43
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Abstract
Endotherapy is now the mainstay of therapy for Barrett's associated neoplasia. The approach should begin with confirmation of neoplasia by a gastrointestinal pathologist, patient counseling, and appropriate endoscopic work up. Detailed examination with high-resolution white light endoscopy is the most important tool for detection of neoplasia. Further validation studies are needed for many enhanced imaging modalities before being recommended as part of the standard work up and assessment of patients with Barrett's esophagus (BE). Endoscopic mucosal resection is required for any visible lesion in the setting of dysplasia for accurate histological diagnosis. The remainder of the epithelium may be treated with resection or ablative therapy, followed by adequate surveillance. Patients with nondysplastic Barrett's require further risk stratification before incorporation of ablative therapy for this population. The future will fortify the endoscopic role in Barrett's with validation trials for endoscopic assessment, further long-term results for each of the treatment modalities, potential risk stratification for patients with BE, and improved guidelines for surveillance after therapy.
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44
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Barrett's Esophagus: Emerging Knowledge and Management Strategies. PATHOLOGY RESEARCH INTERNATIONAL 2012; 2012:814146. [PMID: 22701199 PMCID: PMC3369502 DOI: 10.1155/2012/814146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/08/2012] [Accepted: 03/26/2012] [Indexed: 12/14/2022]
Abstract
The incidence of esophageal adenocarcinoma (EAC) has increased exponentially in the last 3 decades. Barrett's esophagus (BE) is the only known precursor of EAC. Patients with BE have a greater than 40 folds higher risk of EAC compared with the general population. Recent years have witnessed a revolution in the clinical and molecular research related to BE. However, several aspects of this condition remain controversial. Data regarding the true prevalence of BE have varied widely. Recent studies have suggested a lower incidence of EAC in nondysplastic BE (NDBE) than previously reported. There is paucity of prospective data showing a survival benefit of screening or surveillance for BE. Furthermore, the ever-increasing emphasis on healthcare cost containment has called for reexamination of the screening and surveillance strategies for BE. There is a need for identification of reliable clinical predictors or molecular biomarkers to risk-stratify patients who might benefit the most from screening or surveillance for BE. Finally, new therapies have emerged for the management of dysplastic BE. In this paper, we highlight the key areas of controversy and uncertainty surrounding BE. The paper discusses, in detail, the current literature about the molecular pathogenesis, biomarkers, histopathological diagnosis, and management strategies for BE.
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45
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Deb SJ, Shen KR, Deschamps C. An analysis of esophagectomy and other techniques in the management of high-grade dysplasia of Barrett's esophagus. Dis Esophagus 2012; 25:356-66. [PMID: 21518102 DOI: 10.1111/j.1442-2050.2011.01186.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Barrett's esophageal (BE) metaplasia is a premalignant condition of the distal esophagus that develops as a consequence of gastroesophageal reflux disease. The progression to carcinogenesis results from progressive dysplastic changes of the metaplastic epithelium through low-grade and then high-grade dysplasia (HGD) to eventually adenocarcinoma of the esophagus. The management of HGD is controversial with proponents for each of the three major management strategies: endoscopic surveillance, endoscopic ablative therapies, and esophagectomy. The aim of the study was to define and discuss the various management strategies of HGD arising from BE metaplasia. There is a paucity of randomized controlled data from which to draw definitive conclusions. All strategies for the management of HGD are reasonable options and are complimentary. BE with HGD is a malignant lesion. A multidisciplinary approach individualizing therapy should be undertaken when possible. Esophageal resection should be reserved for otherwise healthy patients. Endoscopic techniques are viable alternatives to surgery.
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Affiliation(s)
- S J Deb
- Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, MN 50501, USA
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46
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Yachimski P, Falk GW. Subsquamous intestinal metaplasia: implications for endoscopic management of Barrett's esophagus. Clin Gastroenterol Hepatol 2012; 10:220-4. [PMID: 22020059 DOI: 10.1016/j.cgh.2011.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/28/2011] [Accepted: 10/12/2011] [Indexed: 02/07/2023]
Abstract
Buried Barrett's, or subsquamous intestinal metaplasia (SSIM), is defined as the presence of metaplastic, columnar tissue beneath overlying squamous epithelium. Therefore, SSIM cannot be detected by endoscopic visual examination alone; it is detectable only by tissue biopsy. SSIM can develop in patients with Barrett's esophagus (BE) after chronic pharmacologic suppression of gastric acid; it has been identified before and after endoscopic ablative therapies in cohort studies. It is important to determine the malignant potential of SSIM and the effects of endoscopic therapy for BE on development of SSIM; answers to these questions could affect long-term endoscopic surveillance and ablation strategies for patients with BE.
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Affiliation(s)
- Patrick Yachimski
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5280, USA.
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47
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Ryu CB, Chen YK. Endoscopic Therapy for Gastric Neoplasms. CLINICAL GASTROINTESTINAL ENDOSCOPY 2012:425-447. [DOI: 10.1016/b978-1-4377-1529-3.00033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Dunki-Jacobs EM, Martin RCG. Endoscopic therapy for Barrett's esophagus: a review of its emerging role in optimal diagnosis and endoluminal therapy. Ann Surg Oncol 2011; 19:1575-82. [PMID: 22160480 DOI: 10.1245/s10434-011-2163-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Indexed: 12/13/2022]
Abstract
Barrett's esophagus (BE) is a premalignant lesion known to sequentially progress to esophageal adenocarcinoma. Management of BE has changed significantly over the last 5 years with the development of endoscopic resection and ablation, which has replaced esophagectomy as the treatment of choice in BE with high-grade dysplasia. The aim of this review is to discuss the details of these new endotherapies in regards to response and durability and to define the role of these new therapies in the current management of BE.
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49
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Dua KS, Merrill JT, Komorowski R. Neosquamous epithelium after Barrett's ablation: cause for concern? Gastrointest Endosc 2011; 74:1424-5. [PMID: 21429488 DOI: 10.1016/j.gie.2010.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 12/17/2010] [Indexed: 12/11/2022]
Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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50
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Green S, Bhandari P, DeCaestecker J, Barr H, Ragunath K, Jankowski J, Singh R, Longcroft-Wheaton G, Bennett C. Endoscopic therapies for the prevention and treatment of early esophageal neoplasia. Expert Rev Gastroenterol Hepatol 2011; 5:731-43. [PMID: 22017700 DOI: 10.1586/egh.11.80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Esophageal cancers have traditionally been diagnosed late and prognosis has been dire. For many years the only real treatment option was esophagectomy with substantial morbidity and mortality. This situation has now changed dramatically. Improvements have been achieved in surgical outcomes and there is an array of new effective treatment options now available, particularly for the increasing proportion diagnosed with early-stage disease. Minimally invasive endoscopic therapies can now prevent, cure or palliate esophageal cancers. This article aims to investigate the role and evidence base for these new therapeutic options.
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Affiliation(s)
- Susi Green
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
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