Arvind J Trindade1, Udayakumar Navaneethan2, Harry R Aslanian3, Manoop S Bhutani4, Kumar Krishnan5, David R Lichtenstein6, Joshua Melson7, Rahul Pannala8, Mansour A Parsi9, Allison R Schulman10, Amrita Sethi11, Guru Trikudanathan12, Rabindra R Watson13, John T Maple14. 1. Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, New York. 2. Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida. 3. Section of Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, Connecticut. 4. Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, The University of Texas, Houston, Texas. 5. Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. 6. Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts. 7. Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois. 8. Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona. 9. Department of Gastroenterology and Hepatology, Tulane University, New Orleans, Louisiana. 10. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan. 11. Division of Digestive and Liver Diseases, Columbia University Medical Center-New York-Presbyterian, New York, New York. 12. Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota. 13. Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California. 14. Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Abstract
BACKGROUND AND AIMS: Most patients diagnosed with esophageal adenocarcinoma do not carry a known diagnosis of Barrett's esophagus (BE), suggesting that an improved approach to screening may potentially be of benefit. The use of dysplasia as a biomarker and random biopsy protocols for its detection has limitations. In addition, detecting and appropriately classifying dysplasia in patients with known BE can be difficult. METHODS: This document reviews several technologies with a recently established or potential role in the diagnosis and/or surveillance of BE as well as risk stratification for progression to esophageal adenocarcinoma. RESULTS: Two technologies were reviewed for imaging or tissue sampling: (1) wide-area transepithelial sampling and (2) volumetric laser endomicroscopy. Four technologies were reviewed for molecular and biomarker technologies for diagnosis and risk stratification: (1) Cytosponge, (2) mutational load, (3) fluorescence in situ hybridization, and (4) immunohistochemistry. CONCLUSION: Several technologies discussed in this document may improve dysplasia detection in BE in a wide-field manner. Moreover, the addition of different biomarkers may aid in enhanced risk stratification to optimize approaches to surveillance or treatment for patients with BE.
BACKGROUND AND AIMS: Most patients diagnosed with esophageal adenocarcinoma do not carry a known diagnosis of Barrett's esophagus (BE), suggesting that an improved approach to screening may potentially be of benefit. The use of dysplasia as a biomarker and random biopsy protocols for its detection has limitations. In addition, detecting and appropriately classifying dysplasia in patients with known BE can be difficult. METHODS: This document reviews several technologies with a recently established or potential role in the diagnosis and/or surveillance of BE as well as risk stratification for progression to esophageal adenocarcinoma. RESULTS: Two technologies were reviewed for imaging or tissue sampling: (1) wide-area transepithelial sampling and (2) volumetric laser endomicroscopy. Four technologies were reviewed for molecular and biomarker technologies for diagnosis and risk stratification: (1) Cytosponge, (2) mutational load, (3) fluorescence in situ hybridization, and (4) immunohistochemistry. CONCLUSION: Several technologies discussed in this document may improve dysplasia detection in BE in a wide-field manner. Moreover, the addition of different biomarkers may aid in enhanced risk stratification to optimize approaches to surveillance or treatment for patients with BE.
Authors: Kara L Raphael; Molly Stewart; Divyesh V Sejpal; Mary Cheung; Matthew J Whitson; Dennis Han; Petros C Benias; Calvin Lee; Larry S Miller; Arvind J Trindade Journal: Clin Transl Gastroenterol Date: 2019-12 Impact factor: 4.488