Georgina R Cameron1, Chatura S Jayasekera2, Richard Williams1, Finlay A Macrae3, Paul V Desmond1, Andrew C Taylor1. 1. St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia. 2. St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia. 3. Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Identification and resection of mucosal abnormalities are critical in managing dysplastic Barrett's esophagus (BE) because these areas may harbor esophageal adenocarcinoma (EAC). OBJECTIVES: To compare mucosal lesion and EAC detection rates in dysplastic BE in the community versus a BE unit and assess the impact of EMR on disease staging and management. DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients with dysplastic BE. INTERVENTIONS: Reassessment with high-definition white-light endoscopy (HD-WLE), narrow-band imaging (NBI), and Seattle protocol biopsies. EMR performed in lesions thought to harbor neoplasia. Review of referral histology and endoscopies. MAIN OUTCOME MEASUREMENTS: Mucosal lesion and EAC detection rates in a BE unit versus the community. Impact of EMR on management. RESULTS: Sixty-nine patients were referred (88% male; median age, 69 years). At referral, HD-WLE/NBI use was 57%/14%, and Seattle protocol adherence was 20%. Eighteen patients had intramucosal cancer. Lesions were detected in 65 patients in the BE unit versus 29 patients at referral (P < .001). EMR was performed in 47 patients. BE unit assessment confirmed EAC in all 18 patients and identified 10 additional patients (56% increased cancer detection, P = .036); all 10 had lesions identified in the BE unit (vs 3 identified at referral). EMR in these patients found submucosal cancer (n = 4) and intramucosal cancer (n = 6), resulting in esophagectomy (n = 4) and chemoradiotherapy (n = 1). LIMITATION: Academic center. CONCLUSION: BE assessment at a BE unit resulted in increased lesion and EAC detection. EMR of early cancers was critical in optimizing patient management. These data suggest that BE unit referral be considered in patients with dysplastic BE.
BACKGROUND: Identification and resection of mucosal abnormalities are critical in managing dysplastic Barrett's esophagus (BE) because these areas may harbor esophageal adenocarcinoma (EAC). OBJECTIVES: To compare mucosal lesion and EAC detection rates in dysplastic BE in the community versus a BE unit and assess the impact of EMR on disease staging and management. DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients with dysplastic BE. INTERVENTIONS: Reassessment with high-definition white-light endoscopy (HD-WLE), narrow-band imaging (NBI), and Seattle protocol biopsies. EMR performed in lesions thought to harbor neoplasia. Review of referral histology and endoscopies. MAIN OUTCOME MEASUREMENTS: Mucosal lesion and EAC detection rates in a BE unit versus the community. Impact of EMR on management. RESULTS: Sixty-nine patients were referred (88% male; median age, 69 years). At referral, HD-WLE/NBI use was 57%/14%, and Seattle protocol adherence was 20%. Eighteen patients had intramucosal cancer. Lesions were detected in 65 patients in the BE unit versus 29 patients at referral (P < .001). EMR was performed in 47 patients. BE unit assessment confirmed EAC in all 18 patients and identified 10 additional patients (56% increased cancer detection, P = .036); all 10 had lesions identified in the BE unit (vs 3 identified at referral). EMR in these patients found submucosal cancer (n = 4) and intramucosal cancer (n = 6), resulting in esophagectomy (n = 4) and chemoradiotherapy (n = 1). LIMITATION: Academic center. CONCLUSION: BE assessment at a BE unit resulted in increased lesion and EAC detection. EMR of early cancers was critical in optimizing patient management. These data suggest that BE unit referral be considered in patients with dysplastic BE.
Authors: Cathy Bennett; Paul Moayyedi; Douglas A Corley; John DeCaestecker; Yngve Falck-Ytter; Gary Falk; Nimish Vakil; Scott Sanders; Michael Vieth; John Inadomi; David Aldulaimi; Khek-Yu Ho; Robert Odze; Stephen J Meltzer; Eamonn Quigley; Stuart Gittens; Peter Watson; Giovanni Zaninotto; Prasad G Iyer; Leo Alexandre; Yeng Ang; James Callaghan; Rebecca Harrison; Rajvinder Singh; Pradeep Bhandari; Raf Bisschops; Bita Geramizadeh; Philip Kaye; Sheila Krishnadath; M Brian Fennerty; Hendrik Manner; Katie S Nason; Oliver Pech; Vani Konda; Krish Ragunath; Imdadur Rahman; Yvonne Romero; Richard Sampliner; Peter D Siersema; Jan Tack; Tony C K Tham; Nigel Trudgill; David S Weinberg; Jean Wang; Kenneth Wang; Jennie Y Y Wong; Stephen Attwood; Peter Malfertheiner; David MacDonald; Hugh Barr; Mark K Ferguson; Janusz Jankowski Journal: Am J Gastroenterol Date: 2015-04-14 Impact factor: 10.864
Authors: Georgina R Cameron; Paul V Desmond; Chatura S Jayasekera; Francesco Amico; Richard Williams; Finlay A Macrae; Andrew C F Taylor Journal: Endosc Int Open Date: 2016-08-09