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Systematic Review and Meta-analysis

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis: Igor Logetto Caetité Gomes, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Barbosa Marques, Alexandre de Sousa Carlos, Beanie Conceição Medeiros Nunes, Bruno Salomão Hirsch, Guilherme Henrique Peixoto de Oliveira, Roberto Paolo Trasolini, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2024;57(2):181-190. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.065

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Background
/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported.
Methods
An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate.
Conclusions
Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

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Efficacy and Safety of Cryoablation in Barrett’s Esophagus and Comparison with Radiofrequency Ablation: A Meta-Analysis
Apostolis Papaefthymiou, Benjamin Norton, Andrea Telese, Daryl Ramai, Alberto Murino, Paraskevas Gkolfakis, John Vargo, Rehan J. Haidry
Cancers.2024; 16(17): 2937. CrossRef

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Reviews

Advanced endoscopic imaging for detection of Barrett’s esophagus: Netanel Zilberstein, Michelle Godbee, Neal A. Mehta, Irving Waxman; Clin Endosc 2024;57(1):1-10. Published online January 5, 2024; DOI: https://doi.org/10.5946/ce.2023.031

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Barrett’s esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.

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Advancements in Barrett's esophagus detection: The role of artificial intelligence and its implications
Sara Massironi
World Journal of Gastroenterology.2024; 30(11): 1494. CrossRef

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Role of linked color imaging for upper gastrointestinal disease: present and future: Sang Pyo Lee; Clin Endosc 2023;56(5):546-552. Published online June 9, 2023; DOI: https://doi.org/10.5946/ce.2023.015

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Techniques for upper gastrointestinal endoscopy are advancing to facilitate lesion detection and improve prognosis. However, most early tumors in the upper gastrointestinal tract exhibit subtle color changes or morphological features that are difficult to detect using white light imaging. Linked color imaging (LCI) has been developed to overcome these shortcomings; it expands or reduces color information to clarify color differences, thereby facilitating the detection and observation of lesions. This article summarizes the characteristics of LCI and advances in LCI-related research in the upper gastrointestinal tract field.

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Upper gastrointestinal signs and symptoms: assessment, management and referral pathways
Hasan Alsararatee
Gastrointestinal Nursing.2024; 22(4): 192. CrossRef
Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef

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Systematic Review and Meta-Analysis

Hybrid argon plasma coagulation in Barrett’s esophagus: a systematic review and meta-analysis: Sagar N. Shah, Nabil El Hage Chehade, Amirali Tavangar, Alyssa Choi, Marc Monachese, Kenneth J. Chang, Jason B. Samarasena; Clin Endosc 2023;56(1):38-49. Published online January 30, 2023; DOI: https://doi.org/10.5946/ce.2022.179

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Background
/Aims: Patients with Barrett’s esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.
Methods
We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett’s esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.
Results
Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872–0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005–0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007–0.055; I2=0%).
Conclusions
Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

Citations

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Application of electrosurgery in gastrointestinal endoscopy

Progress in Medical Devices.2024;[Epub] CrossRef
Hybrid Argon Plasma Coagulation for Barrett’s Esophagus and for Colonic Mucosal Resection—A Systematic Review and Meta-Analysis
Maria Manuela Estevinho, Rolando Pinho, João Carlos Silva, João Correia, Pedro Mesquita, Teresa Freitas
Biomedicines.2023; 11(4): 1139. CrossRef
Hybrid-APC treatment for gastric vascular ectasia of atypical location after failed radiofrequency ablation
José Manuel Palma García, Raúl Honrubia López, Cristina Fernández de Castro, Carmen Comas Redondo
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef
Thermal ablative therapies in the gastrointestinal tract
Hendrik Manner
Current Opinion in Gastroenterology.2023; 39(5): 370. CrossRef
Endoscopic Management of Dysplastic Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma
Leonardo Henry Eusebi, Andrea Telese, Chiara Castellana, Rengin Melis Engin, Benjamin Norton, Apostolis Papaefthymiou, Rocco Maurizio Zagari, Rehan Haidry
Cancers.2023; 15(19): 4776. CrossRef
Critical Decision Making: Technical Aspects of Esophageal Ablation
Felice Schnoll-Sussman
Foregut: The Journal of the American Foregut Society.2023; 3(3): 314. CrossRef

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Review

Role of artificial intelligence in diagnosing Barrett’s esophagus-related neoplasia: Michael Meinikheim, Helmut Messmann, Alanna Ebigbo; Clin Endosc 2023;56(1):14-22. Published online January 17, 2023; DOI: https://doi.org/10.5946/ce.2022.247

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Barrett’s esophagus is associated with an increased risk of adenocarcinoma. Thorough screening during endoscopic surveillance is crucial to improve patient prognosis. Detecting and characterizing dysplastic or neoplastic Barrett’s esophagus during routine endoscopy are challenging, even for expert endoscopists. Artificial intelligence-based clinical decision support systems have been developed to provide additional assistance to physicians performing diagnostic and therapeutic gastrointestinal endoscopy. In this article, we review the current role of artificial intelligence in the management of Barrett’s esophagus and elaborate on potential artificial intelligence in the future.

Citations

Citations to this article as recorded by

Endoskopische Therapie von Barrett-Neoplasien und Magenfrühkarzinomen
Florian Berreth, Jan Peveling-Oberhag, Jörg G. Albert
best practice onkologie.2024; 19(1-2): 28. CrossRef
The Role of Screening and Early Detection in Upper Gastrointestinal Cancers
Jin Woo Yoo, Monika Laszkowska, Robin B. Mendelsohn
Hematology/Oncology Clinics of North America.2024; 38(3): 693. CrossRef
Artificial intelligence in gastroenterology: where are we and where are we going?
Laurence B Lovat
Gastrointestinal Nursing.2024; 22(Sup3): S6. CrossRef
As how artificial intelligence is revolutionizing endoscopy
Jean-Francois Rey
Clinical Endoscopy.2024; 57(3): 302. CrossRef
Screening and Diagnostic Advances of Artificial Intelligence in Endoscopy
Muhammed Yaman Swied, Mulham Alom, Obada Daaboul, Abdul Swied
Innovations in Digital Health, Diagnostics, and Biomarkers.2024; 4(2024): 31. CrossRef
Endoscopic Artificial Intelligence for Image Analysis in Gastrointestinal Neoplasms
Ryosuke Kikuchi, Kazuaki Okamoto, Tsuyoshi Ozawa, Junichi Shibata, Soichiro Ishihara, Tomohiro Tada
Digestion.2024; : 1. CrossRef
Endoskopische Therapie von Barrett-Neoplasien und Magenfrühkarzinomen
Florian Berreth, Jan Peveling-Oberhag, Jörg G. Albert
Die Gastroenterologie.2023; 18(3): 186. CrossRef

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Case Reports

Buried Barrett’s Esophagus with High-Grade Dysplasia after Radiofrequency Ablation: Joana Castela, Miguel Serrano, Susana Mão de Ferro, Daniela Vinha Pereira, Paula Chaves, António Dias Pereira; Clin Endosc 2019;52(3):269-272. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.124

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Radiofrequency ablation therapy is an effective endoscopic option for the eradication of Barrett’s esophagus that appears to reduce the risk of esophageal cancer. A concern associated with this technique is the development of subsquamous/buried intestinal metaplasia, whose clinical relevance and malignant potential have not yet been fully elucidated. Fewer than 20 cases of subsquamous neoplasia after the successful radiofrequency ablation of Barrett’s esophagus have been reported to date. Here, we describe a new case of subsquamous neoplasia (high-grade dysplasia) following radiofrequency ablation that was managed with endoscopic resection. Our experience suggests that a meticulous endoscopic inspection prior to and after radiofrequency ablation is fundamental to reduce the risk of buried neoplasia development.

Citations

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Allaying uncertainty in diagnosing buried Barrett's esophagus
Ryan Demkowicz, Prashanthi N. Thota, Tanmayee Benjamin, Rocio Lopez, Haiyan Lu, Deepa T. Patil, Erinn Downs-Kelly, Jennifer A. Jeung, Keith K. Lai, James Lapinski, Erica C. Savage, John R. Goldblum, Ilyssa O. Gordon
Annals of Diagnostic Pathology.2021; 51: 151672. CrossRef
Endoscopic features of buried Barrett’s mucosa
Linda S. Yang, Bronte A. Holt, Richard Williams, Richard Norris, Edward Tsoi, Georgina Cameron, Paul Desmond, Andrew C.F. Taylor
Gastrointestinal Endoscopy.2021; 94(1): 14. CrossRef
Post-ablation buried neoplasia in Barrett’s esophagus
Prabhat Kumar, Ilyssa O. Gordon, Prashanthi N. Thota
Scandinavian Journal of Gastroenterology.2021; 56(5): 624. CrossRef
Role of optical coherence tomography in Barrett’s esophagus
Nikhil Gupta, Raghav Yelamanchi, Himanshu Agrawal, Nitin Agarwal
Artificial Intelligence in Gastrointestinal Endoscopy.2021; 2(4): 149. CrossRef
Indications, contraindications and limitations of endoscopic therapy for Barrett’s esophagus and early esophageal adenocarcinoma
Carol Rouphael, Mythri Anil Kumar, Madhusudhan R. Sanaka, Prashanthi N. Thota
Therapeutic Advances in Gastroenterology.2020; 13: 175628482092420. CrossRef
Risk Factors for Self-Expandable Metal Stent Complications in the Treatment of Esophageal Cancer: A Scoping Review
Connor K. Wilson, Sara R. Frankowski, Susan C. Steelman, Issam Makhoul
SN Comprehensive Clinical Medicine.2020; 2(8): 1163. CrossRef
Multifocal Cryoballoon Ablation for Eradication of Barrett's Esophagus-Related Neoplasia: A Prospective Multicenter Clinical Trial
Marcia Irene Canto, Arvind J. Trindade, Julian Abrams, Michael Rosenblum, John Dumot, Amitabh Chak, Prasad Iyer, David Diehl, Harshit S. Khara, F. Scott Corbett, Matthew McKinley, Eun Ji Shin, Irving Waxman, Anthony Infantolino, Christina Tofani, Jason Sa
American Journal of Gastroenterology.2020; 115(11): 1879. CrossRef
Inflammatory bowel disease- and Barrett’s esophagus-associated neoplasia: the old, the new, and the persistent struggles
Dipti M Karamchandani, Qin Zhang, Xiao-Yan Liao, Jing-Hong Xu, Xiu-Li Liu
Gastroenterology Report.2019; 7(6): 379. CrossRef

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Laser Imaging Facilitates Early Detection of Synchronous Adenocarcinomas in Patients with Barrett’s Esophagus: Chihiro Iwashita, Yoshimasa Miura, Hiroyuki Osawa, Takahito Takezawa, Yuji Ino, Masahiro Okada, Alan K. Lefor, Hironori Yamamoto; Clin Endosc 2017;50(1):81-86. Published online May 9, 2016; DOI: https://doi.org/10.5946/ce.2016.027

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Barrett’s adenocarcinoma may occur in multiple sites, and recurrence and metachronous lesions are the major problems with endoscopic resection. Therefore, early detection of such lesions is ideal to achieve complete resection and obtain improved survival rates with minimally invasive treatment. Laser imaging systems allow multiple modalities of endoscopic imaging by using white light laser, flexible spectral imaging color enhancement (FICE), blue laser imaging (BLI), and linked color imaging even at a distant view. However, the usefulness of these modalities has not been sufficiently reported regarding Barrett’s adenocarcinoma. Here, we report on a patient with three synchronous lesions followed by one metachronous lesion in a long segment with changes of Barrett’s esophagus, all diagnosed with this new laser endoscopic imaging system and enhanced by using FICE and/or BLI with high contrast compared with the surrounding mucosa. Laser endoscopic imaging may facilitate the detection of malignancies in patients with early Barrett’s adenocarcinoma.

Citations

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Validation of simplified classification of magnifying endoscopy for diagnosis of Barrett's dysplasia with blue laser imaging
Tzu‐Haw Chen, Ro‐Ting Lin, Wen‐Lun Wang, Ching‐Tai Lee, Cheng‐Hao Tseng, Wen‐Hung Hsu, Wei‐Chen Tai, Hsiu‐Po Wang, Chi‐Yang Chang
Advances in Digestive Medicine.2022; 9(1): 10. CrossRef
Opciones terapéuticas en el tratamiento del cáncer precoz de la unión esofagogástrica
Félix Junquera, Sonia Fernández-Ananín, Carmen Balagué
Cirugía Española.2019; 97(8): 438. CrossRef
Blue Laser Imaging with a Small-Caliber Endoscope Facilitates Detection of Early Gastric Cancer
Haruo Takahashi, Yoshimasa Miura, Hiroyuki Osawa, Takahito Takezawa, Yuji Ino, Masahiro Okada, Alan Kawarai Lefor, Hironori Yamamoto
Clinical Endoscopy.2019; 52(3): 273. CrossRef
Therapeutic Options for Early Cancer of the Esophagogastric Junction
Félix Junquera, Sonia Fernández-Ananín, Carmen Balagué
Cirugía Española (English Edition).2019; 97(8): 438. CrossRef
How to get the most out of costly Barrett’s oesophagus surveillance
Barbara Braden, Evonne Jones-Morris
Digestive and Liver Disease.2018; 50(9): 871. CrossRef
Linked Color Imaging and Blue Laser Imaging for Upper Gastrointestinal Screening
Hiroyuki Osawa, Yoshimasa Miura, Takahito Takezawa, Yuji Ino, Tsevelnorov Khurelbaatar, Yuichi Sagara, Alan Kawarai Lefor, Hironori Yamamoto
Clinical Endoscopy.2018; 51(6): 513. CrossRef
Image assessment of Barrett’s esophagus using the simplified narrow band imaging classification
Masayuki Kato, Kenichi Goda, Yuichi Shimizu, Akira Dobashi, Masakazu Takahashi, Masahiro Ikegami, Tadakazu Shimoda, Mototsugu Kato, Prateek Sharma
Journal of Gastroenterology.2017; 52(4): 466. CrossRef
Animal experimental studies using small intestine endoscope
Jin-Hua Liu, Dan-Yang Liu, Li Wang, Li-Ping Han, Zhe-Yu Qi, Hai-Jun Ren, Yan Feng, Feng-Ming Luan, Liang-Tian Mi, Shu-Mei Shan
World Journal of Gastroenterology.2017; 23(20): 3684. CrossRef

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Original Article

Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection: Bashar Qumseya, Abraham M. Panossian, Cynthia Rizk, David Cangemi, Christianne Wolfsen, Massimo Raimondo, Timothy Woodward, Michael B. Wallace, Herbert Wolfsen; Clin Endosc 2014;47(2):155-161. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.155

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Background/Aims

Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied.

Methods

We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors.

Results

Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007).

Conclusions

Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.

Citations

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Simplified Versus Standard Radiofrequency Ablation Protocols for Barrett's Esophagus: A Systematic Review and Meta-Analysis
Sagar Shah, Mary Kathryn Roccato, Samuel Ji, Neil Jariwalla, Spencer Kozik, Ronald Dungca Ortizo, Anastasia Chahine, Jennifer M. Kolb, Jason B. Samarasena
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(1): 45. CrossRef
A reliable nomogram model for predicting esophageal stricture after endoscopic submucosal dissection
Guodong Yang, Zhao Mu, Ke Pu, Yulin Chen, Luoyao Zhang, Haiyue Zhou, Peng Luo, Xiaoying Zhang
Medicine.2022; 101(5): e28741. CrossRef
Management of esophageal strictures after endoscopic resection for early neoplasia
Einas Abou Ali, Arthur Belle, Rachel Hallit, Benoit Terris, Frédéric Beuvon, Mahaut Leconte, Anthony Dohan, Sarah Leblanc, Solène Dermine, Lola-Jade Palmieri, Romain Coriat, Stanislas Chaussade, Maximilien Barret
Therapeutic Advances in Gastroenterology.2021; 14: 175628482098529. CrossRef
Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection
Meihong Chen, Yini Dang, Chao Ding, Jiajia Yang, Xinmin Si, Guoxin Zhang
Surgical Endoscopy.2020; 34(9): 4065. CrossRef
Risk factors for serious adverse events associated with multiband mucosectomy in Barrett’s esophagus: an international multicenter analysis of 3827 endoscopic resection procedures
Kamar Belghazi, Norman Marcon, Christopher Teshima, Kenneth K. Wang, Reza V. Milano, Nahid Mostafavi, Michael B. Wallace, Pujan Kandel, Lady Katherine Mejía Pérez, Michael J. Bourke, Farzan Bahin, Martin A. Everson, Rehan Haidry, Gregory G. Ginsberg, Gene
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Don C. Codipilly, Prasad G. Iyer
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Adriana Ciocalteu, Petrica Popa, Mircea Ionescu, Dan Ionut Gheonea
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Ivan Kristo, Erwin Rieder, Matthias Paireder, Katrin Schwameis, Gerd Jomrich, Werner Dolak, Thomas Parzefall, Martin Riegler, Reza Asari, Sebastian F. Schoppmann
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Endoscopic submucosal dissection for early Barrett’s neoplasia: a meta-analysis
Dennis Yang, Fei Zou, Sican Xiong, Justin J. Forde, Yu Wang, Peter V. Draganov
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Swarup Kumar, Prasad G. Iyer
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Recent advances in Barrett's esophagus
John Inadomi, Hani Alastal, Luigi Bonavina, Seth Gross, Richard H. Hunt, Hiroshi Mashimo, Massimiliano di Pietro, Horace Rhee, Marmy Shah, Salvatore Tolone, David H. Wang, Shao‐Hua Xie
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Stephanie Worrell, Steven R. DeMeester
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Ashley H. Davis-Yadley, Kevin G. Neill, Mokenge P. Malafa, Luis R. Peña
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Joo Ha Hwang, Vani Konda, Barham K. Abu Dayyeh, Shailendra S. Chauhan, Brintha K. Enestvedt, Larissa L. Fujii-Lau, Sri Komanduri, John T. Maple, Faris M. Murad, Rahul Pannala, Nirav C. Thosani, Subhas Banerjee
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Focused Review Series: Endoscopic and Molecular Imagings of Premalignant GI Lesions, Part II

Recent Advances in Molecular Imaging of Premalignant Gastrointestinal Lesions and Future Application for Early Detection of Barrett Esophagus: Kwang Hyun Ko, Na Young Han, Chang Il Kwon, Hoo Keun Lee, Jong Min Park, Eun Hee Kim, Ki Baik Hahm; Clin Endosc 2014;47(1):7-14. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.7

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Recent advances in optical molecular imaging allow identification of morphologic and biochemical changes in tissues associated with gastrointestinal (GI) premalignant lesions earlier and in real-time. This focused review series introduces high-resolution imaging modalities that are being evaluated preclinically and clinically for the detection of early GI cancers, especially Barrett esophagus and esophageal adenocarcinoma. Although narrow band imaging, autofluorescence imaging, and chromoendoscopy are currently applied for this purpose in the clinic, further adoptions of probe-based confocal laser endomicroscopy, high-resolution microendoscopy, optical coherence tomography, and metabolomic imaging, as well as imaging mass spectrometry, will lead to detection at the earliest and will guide predictions of the clinical course in the near future in a manner that is beyond current advancements in optical imaging. In this review article, the readers will be introduced to sufficient information regarding this matter with which to enjoy this new era of high technology and to confront science in the field of molecular medical imaging.

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hERG1 behaves as biomarker of progression to adenocarcinoma in Barrett's esophagus and can be exploited for a novel endoscopic surveillance
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Imaging Mass Spectrometry in Papillary Thyroid Carcinoma for the Identification and Validation of Biomarker Proteins
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Treatment of Dysplasia in Barrett Esophagus: Javier Aranda-Hernandez, Maria Cirocco, Norman Marcon; Clin Endosc 2014;47(1):55-64. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.55

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Barrett esophagus is recognized as a risk factor for the development of dysplasia and adenocarcinoma of the esophagus. Cancer is usually diagnosed at an advanced stage with a 5-year survival rate of 15%. Most of these patients present de novo and are not part of a surveillance program. Endoscopic screening with improvement in recognition of early lesions may change this pattern. In the past, patients diagnosed with dysplasia and mucosal cancer were best managed by esophagectomy. Endoscopic techniques such as endoscopic mucosal resection and radiofrequency ablation have resulted in high curative rates and a shift away from esophagectomy. This pathway is supported by the literature review of esophagectomies performed for mucosal disease, as well as pathologists' interpretation of endoscopic mucosal specimens, which document the low risk of lymph node metastasis. The role of endoscopic therapy for superficial submucosal disease continues to be a challenge.

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Determination of regional lymph node status using18F-FDG PET/CT parameters in oesophageal cancer patients: comparison of SUV, volumetric parameters and intratumoral heterogeneity
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Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer
Ru Tan, Shu-Zhan Yao, Zhao-Qin Huang, Jun Li, Xin Li, Hai-Hua Tan, Qing-Wei Liu
Asian Pacific Journal of Cancer Prevention.2014; 15(18): 7719. CrossRef

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Advanced Imaging Technologies for the Detection of Dysplasia and Early Cancer in Barrett Esophagus: Alberto Espino, Maria Cirocco, Ralph DaCosta, Norman Marcon; Clin Endosc 2014;47(1):47-54. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.47

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Advanced esophageal adenocarcinomas arising from Barrett esophagus (BE) are tumors with an increasing incidence and poor prognosis. The aim of endoscopic surveillance of BE is to detect dysplasia, particularly high-grade dysplasia and intramucosal cancers that can subsequently be treated endoscopically before progression to invasive cancer with lymph node metastases. Current surveillance practice standards require the collection of random 4-quadrant biopsy specimens over every 1 to 2 cm of BE (Seattle protocol) to detect dysplasia with the assistance of white light endoscopy, in addition to performing targeted biopsies of recognizable lesions. This approach is labor-intensive but should currently be considered state of the art. Chromoendoscopy, virtual chromoendoscopy (e.g., narrow band imaging), and confocal laser endomicroscopy, in addition to high-definition standard endoscopy, might increase the diagnostic yield for the detection of dysplastic lesions. Until these modalities have been demonstrated to enhance efficiency or cost effectiveness, the standard protocol will remain careful examination using conventional off the shelf high-resolution endoscopes, combined with as longer inspection time which is associated with increased detection of dysplasia.

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Chinese consensus on multidisciplinary diagnosis and treatment of gastroesophageal reflux disease 2022
Zhiwei Hu, Jimin Wu, Zhonggao Wang, Xinghua Bai, Yu Lan, Kefang Lai, Abudureyimu Kelimu, Feng Ji, Zhenling Ji, Diyu Huang, Zhiwei Hu, Xiaohua Hou, Jianyu Hao, Zhining Fan, Xiaoping Chen, Dong Chen, Shengliang Chen, Jinrang Li, Junxiang Li, Lan Li, Peng Li
Gastroenterology & Endoscopy.2023; 1(2): 33. CrossRef
Endoscopic Diagnosis and Management of Barrett’s Esophagus with Low-Grade Dysplasia
Francesco Maione, Alessia Chini, Rosa Maione, Michele Manigrasso, Alessandra Marello, Gianluca Cassese, Nicola Gennarelli, Marco Milone, Giovanni Domenico De Palma
Diagnostics.2022; 12(5): 1295. CrossRef
Taking the Next Steps in Endoscopic Visual Assessment of Barrett’s Esophagus: A Pilot Study
Roxana Chis, Simon Hew, Wilma Hopman, Lawrence Hookey, Robert Bechara
Clinical and Experimental Gastroenterology.2021; Volume 14: 113. CrossRef
Machine Learning Creates a Simple Endoscopic Classification System that Improves Dysplasia Detection in Barrett’s Oesophagus amongst Non-expert Endoscopists
Vinay Sehgal, Avi Rosenfeld, David G. Graham, Gideon Lipman, Raf Bisschops, Krish Ragunath, Manuel Rodriguez-Justo, Marco Novelli, Matthew R. Banks, Rehan J. Haidry, Laurence B. Lovat
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Care of the Postablation Patient
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Guido Costamagna, Giorgio Battaglia, Alessandro Repici, Roberto Fiocca, Massimo Rugge, Cristiano Spada, Vincenzo Villanacci
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Post-ablation surveillance in Barrett's esophagus: A review of the literature
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Barrett Esophagus: When to Endoscope: Joshua Butt, Gabor Kandel; Clin Endosc 2014;47(1):40-46. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.40

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Increasing interest in identifying an effective strategy for decreasing the burden of esophageal adenocarcinoma (EAC) has been fuelled by the rising EAC rates worldwide, the morbidity associated with esophagectomy, and the development of endoscopic methods for curing early-stage EAC. In the face of this enthusiasm, however, we should be cautious about continuing our current evidence-free approach to screening and one with unclear benefits and unclear costs to the community. The literature is increasingly recognizing that the value of traditional endoscopy for screening and surveillance of Barrett esophagus may be more limited than initially believed. A better understanding of the risk factors for Barrett esophagus and progression to dysplasia and a more individualized risk calculation will be useful in defining populations to consider for Barrett screening. The development of novel, nonendoscopic screening techniques and of less expensive endoscopic techniques holds promise for a cost-effective screening and surveillance method to curtail the increasing rates of EAC.

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The importance of a second opinion in the diagnosis of Barretts esophagus: a real life study
Vincenzo Villanacci, Marianna Salemme, Italo Stroppa, Valerio Balassone, Gabrio Bassotti
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Diagnostic Accuracy of Mucosal Biopsy versus Endoscopic Mucosal Resection in Barrett’s Esophagus and Related Superficial Lesions
Hany M. Elsadek, Mamdouh M. Radwan
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Aneusomy detected by fluorescence in‐situ hybridization has high positive predictive value for Barrett's dysplasia
Euan A G Allan, Roy Miller, James J Going
Histopathology.2015; 67(4): 451. CrossRef
Endoscopic surveillance of gastrointestinal premalignant lesions
Veroushka Ballester, Marcia Cruz-Correa
Current Opinion in Gastroenterology.2014; 30(5): 477. CrossRef

7,601 View
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Histopathology in Barrett Esophagus and Barrett Esophagus-Related Dysplasia: Andrea Grin, Catherine J. Streutker; Clin Endosc 2014;47(1):31-39. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.31

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Pathologic specimens, both biopsies and endoscopic mucosal resections, for Barrett esophagus and Barrett-associated dysplasia and malignancy are common for pathologists in North America, and the incidence in South Asian countries seems to be increasing. Dysplasia and malignancy arising in intestinalized gastric-type mucosa raises issues in the interpretation of dysplasia and the evaluation of the depth of invasion of malignancies that are not seen in squamous dysplasia and squamous cell carcinoma. We review the North American approach to these lesions.

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Complete circumferential endoscopic submucosal dissection for early Barrett’s neoplasia
Douglas Motomura, Robert Bechara
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Ksenia S. Maslyonkina, Alexandra K. Konyukova, Darya Y. Alexeeva, Mikhail Y. Sinelnikov, Liudmila M. Mikhaleva
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Matrix metalloproteinase (MMP)-7 in Barrett's esophagus and esophageal adenocarcinoma: expression, metabolism, and functional significance
Hanan M. Garalla, Nantaporn Lertkowit, Laszlo Tiszlavicz, Zita Reisz, Chris Holmberg, Rob Beynon, Deborah Simpson, Akos Varga, Jothi Dinesh Kumar, Steven Dodd, David Mark Pritchard, Andrew R. Moore, András I. Rosztóczy, Tibor Wittman, Alec Simpson, Graham
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Confocal Laser Endomicroscopy and Molecular Imaging in Barrett Esophagus and Stomach: Kwi-Sook Choi, Hwoon-Yong Jung; Clin Endosc 2014;47(1):23-30. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.23

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Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.

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The Use of Confocal Laser Endomicroscopy in Diagnosing Barrett’s Esophagus and Esophageal Adenocarcinoma
Jitka Vaculová, Radek Kroupa, Zdeněk Kala, Jiří Dolina, Tomáš Grolich, Jakub Vlažný, David Said, Lydie Izakovičová Hollá, Petra Bořilová Linhartová, Vladimír Procházka, Marek Joukal, Petr Jabandžiev, Ondřej Slabý, Lumír Kunovský
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Probe‐based confocal laser endomicroscopy versus biopsies in the diagnostics of oesophageal and gastric lesions: A prospective, pathologist‐blinded study
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United European Gastroenterology Journal.2020; 8(4): 436. CrossRef

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Barrett Esophagus in Asia: Same Disease with Different Pattern: Hyun Seok Lee, Seong Woo Jeon; Clin Endosc 2014;47(1):15-22. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.15

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Barrett esophagus (BE) is considered to develop as a result of chronic gastroesophageal reflux disease (GERD) and to predispose to esophageal adenocarcinoma (EAC). However, the disease pattern of BE in Asia differs from that observed in the West. For example, in the West, the prevalence rates of BE and EAC have progressively increased, whereas although the prevalence rate of GERD is increasing in Asia, the prevalence rates of BE and EAC have remained low in most Asian countries. GERD, hiatal hernia, old age, male sex, abdominal obesity (visceral obesity), smoking, alcohol consumption, and kyphosis are known risk factors for BE in Asia, and most Asian patients have short-segment BE. Helicobacter pylori infection is more prevalent in Asia than in the West. We suggest larger studies with a prospective design be conducted to elaborate further the different patterns of BE in Asia.

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Special Issue Article of IDEN 2013

Confocal Microscopy in the Esophagus and Stomach: Adam Templeton, Joo Ha Hwang; Clin Endosc 2013;46(5):445-449. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.445

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Probe-based confocal microscopy (pCLE) is actively being investigated for applications in the esophagus and stomach. The use of pCLE allows real-time in vivo microscopy to evaluate the microarchitecture of the mucosal epithelium. pCLE appears to be particularly useful in identifying mucosal dysplasia and early malignancies that cannot be clearly distinguished using high-definition white light endoscopy, chromoendoscopy, or magnification endoscopy. In addition, the ability to detect dysplastic tissue in real-time may shift the current screening practice from random biopsy to targeted biopsy of esophageal and gastric cancers and their precursor lesions. We will review the use of pCLE for detection and surveillance of upper gastrointestinal early luminal malignancy.

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Focused Review Series: Photodynamic Therapy

Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma: Bashar J. Qumseya, Waseem David, Herbert C. Wolfsen; Clin Endosc 2013;46(1):30-37. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.30

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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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Review

Endoscopic Imaging in Barrett's Oesophagus: Applications in Routine Clinical Practice and Future Outlook: Sam Costello, Rajvinder Singh; Clin Endosc 2011;44(2):87-92. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.87

Abstract PDF PubReader ePub

The practice for endoscopic surveillance of Barrett's oesophagus has evolved from "blind" or random 4 quadrant biopsies (Seattle protocol) to a more "intelligent" targeted biopsy approach. This evolution has been possible due to the rapid advances in endoscopic imaging technology and expertise in the last decade. Previous endoscopes had relatively poor image resolution that often did not allow the subtle mucosal changes associated with dysplastic Barrett's mucosa to be identified. Newer endoscopic imaging techniques available today may allow endoscopists to identify areas of dysplasia or malignancy and target biopsies accordingly. These modalities which include narrow band imaging, chromoendoscopy, autofluorescence imaging, and confocal endomicroscopy as well as a few novel imaging modalities on the horizon will be discussed further.

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