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Endoscopic Management of Barrett's Esophagus

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References

  1. Kolb JM, Han S, Scott FI et al. Early-onset esophageal adenocarcinoma presents with advanced-stage disease but has improved survival compared with older individuals. Gastroenterology 2020;159:2238-2240 e4.

    Article  PubMed  Google Scholar 

  2. Curtius K, Rubenstein JH, Chak A et al. Computational modelling suggests that Barrett’s oesophagus may be the precursor of all oesophageal adenocarcinomas. Gut 2020;70:1435–1440.

    Article  Google Scholar 

  3. Kolb JM, Wani S. A paradigm shift in screening for Barrett’s esophagus: the BEST Is Yet to come. Gastroenterology 2021;160:467–469.

    Article  PubMed  Google Scholar 

  4. Thrift AP. Barrett’s esophagus and esophageal adenocarcinoma: How common are they really? Dig Dis Sci 2018;63:1988–1996.

    Article  PubMed  Google Scholar 

  5. Hammad TA, Thrift AP, El-Serag HB et al. Missed opportunities for screening and surveillance of Barrett’s esophagus in veterans with esophageal adenocarcinoma. Dig Dis Sci 2019;64:367–372.

    Article  PubMed  Google Scholar 

  6. Visrodia K, Singh S, Krishnamoorthi R et al. Magnitude of missed esophageal adenocarcinoma after Barrett’s esophagus diagnosis: a systematic review and meta-analysis. Gastroenterology 2016;150:599-607 e7; quiz e14-5.

    Article  PubMed  Google Scholar 

  7. Asge Standards Of Practice C, Qumseya B, Sultan S, et al. ASGE guideline on screening and surveillance of Barrett's esophagus. Gastrointest Endosc 2019;90:335–359 e2.

  8. Beg S, Ragunath K, Wyman A et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017;66:1886–1899.

    Article  PubMed  Google Scholar 

  9. Weusten B, Bisschops R, Coron E et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy 2017;49:191–198.

    Article  PubMed  Google Scholar 

  10. Fock KM, Talley N, Goh KL et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett’s oesophagus. Gut 2016;65:1402–1415.

    Article  PubMed  Google Scholar 

  11. Shaheen NJ, Falk GW, Iyer PG et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016;111:30–50; quiz 51.

    Article  CAS  PubMed  Google Scholar 

  12. Kolb JM, Wani S. Barrett’s esophagus: current standards in advanced imaging. Transl Gastroenterol Hepatol 2021;6:14.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sharma P, Savides TJ, Canto MI et al. The American Society for gastrointestinal endoscopy PIVI (preservation and incorporation of valuable endoscopic innovations) on imaging in Barrett’s esophagus. Gastrointest Endosc 2012;76:252–254.

    Article  PubMed  Google Scholar 

  14. Sharma P, Dent J, Armstrong D et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006;131:1392–1399.

    Article  PubMed  Google Scholar 

  15. Endoscopic Classification Review G. Update on the paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 2005;37:570–8.

  16. Wani S, Williams JL, Falk GW et al. An analysis of the GIQuIC nationwide quality registry reveals unnecessary surveillance endoscopies in patients with normal and irregular Z-lines. Am J Gastroenterol 2020;115:1869–1878.

    Article  PubMed  Google Scholar 

  17. Wani S, Rubenstein JH, Vieth M et al. Diagnosis and management of low-grade dysplasia in Barrett’s esophagus: expert review from the clinical practice updates committee of the American Gastroenterological Association. Gastroenterology 2016;151:822–835.

    Article  PubMed  Google Scholar 

  18. Hashimoto R, Requa J, Dao T et al. Artificial intelligence using convolutional neural networks for real-time detection of early esophageal neoplasia in Barrett’s esophagus (with video). Gastrointest Endosc 2020;91:1264-1271 e1.

    Article  PubMed  Google Scholar 

  19. Ebigbo A, Mendel R, Probst A et al. Real-time use of artificial intelligence in the evaluation of cancer in Barrett’s oesophagus. Gut 2020;69:615–616.

    Article  PubMed  Google Scholar 

  20. Struyvenberg MR, de Groof AJ, van der Putten J et al. A computer-assisted algorithm for narrow-band imaging-based tissue characterization in Barrett’s esophagus. Gastrointest Endosc 2021;93:89–98.

    Article  PubMed  Google Scholar 

  21. Trindade AJ, McKinley MJ, Fan C et al. Endoscopic surveillance of Barrett’s esophagus using volumetric laser endomicroscopy with artificial intelligence image enhancement. Gastroenterology 2019;157:303–305.

    Article  PubMed  Google Scholar 

  22. Struyvenberg MR, van der Sommen F, Swager AF, et al. Improved Barrett's neoplasia detection using computer-assisted multiframe analysis of volumetric laser endomicroscopy. Dis Esophagus 2020;33.

  23. de Groof J, van der Sommen F, van der Putten J et al. The Argos project: the development of a computer-aided detection system to improve detection of Barrett’s neoplasia on white light endoscopy. United Eur Gastroenterol J 2019;7:538–547.

    Article  Google Scholar 

  24. de Groof AJ, Struyvenberg MR, van der Putten J et al. Deep-learning system detects neoplasia in patients with Barrett’s esophagus with higher accuracy than endoscopists in a multistep training and validation study with benchmarking. Gastroenterology 2020;158:915-929.e4.

    Article  PubMed  Google Scholar 

  25. Wani S, Gyawali CP, Katzka DA. AGA clinical practice update on reducing rates of post-endoscopy esophageal adenocarcinoma: commentary. Gastroenterology 2020;159:1533–1537.

    Article  PubMed  Google Scholar 

  26. Vajravelu RK, Kolb JM, Thanawala SU, et al. Characterization of prevalent, post-endoscopy, and incident esophageal cancer in the United States: a large retrospective cohort study. Clin Gastroenterol Hepatol 2021. https://doi.org/10.1016/j.cgh.2021.02.005.

  27. Sawas T, Majzoub AM, Haddad J, et al. Magnitude and time-trend analysis of post-endoscopy esophageal adenocarcinoma: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2021;20:e31–e50.

  28. Kolb JM, Wani S. Endoscopic eradication therapy for Barrett’s oesophagus: state of the art. Curr Opin Gastroenterol 2020;36:351–358.

    Article  PubMed  Google Scholar 

  29. Krishnamoorthi R, Singh S, Ragunathan K et al. Factors Associated With Progression of Barrett’s Esophagus: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018;16:1046-1055 e8.

    Article  PubMed  Google Scholar 

  30. Wani S, Muthusamy VR, Shaheen NJ et al. Development of quality indicators for endoscopic eradication therapies in barrett’s esophagus: The TREAT-BE (treatment with resection and endoscopic ablation techniques for Barrett’s esophagus) consortium. Am J Gastroenterol 2017;112:1032–1048.

    Article  PubMed  Google Scholar 

  31. Sharma P, Katzka DA, Gupta N et al. Quality indicators for the management of Barrett’s esophagus, dysplasia, and esophageal adenocarcinoma: international consensus recommendations from the American Gastroenterological Association Symposium. Gastroenterology 2015;149:1599–1606.

    Article  PubMed  Google Scholar 

  32. Han S, Kolb JM, Hosokawa P et al. The volume-outcome effect calls for centralization of care in esophageal adenocarcinoma: results from a large national cancer registry. Am J Gastroenterol 2021;116:811–815.

    Article  PubMed  Google Scholar 

  33. Desai TK, Krishnan K, Samala N et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut 2012;61:970–976.

    Article  PubMed  Google Scholar 

  34. Omidvari AH, Ali A, Hazelton WD et al. Optimizing management of patients with Barrett’s esophagus and low-grade or no dysplasia based on comparative modeling. Clin Gastroenterol Hepatol 2020;18:1961–1969.

    Article  PubMed  Google Scholar 

  35. Duits LC, Lao-Sirieix P, Wolf WA, et al. A biomarker panel predicts progression of Barrett's esophagus to esophageal adenocarcinoma. Dis Esophagus 2019;32.

  36. Frei NF, Konte K, Bossart EA et al. Independent Validation of a Tissue Systems Pathology Assay to Predict Future Progression in Nondysplastic Barrett’s Esophagus: A Spatial-Temporal Analysis. Clin Transl Gastroenterol 2020;11:e00244.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Davison JM, Goldblum J, Grewal US et al. Independent blinded validation of a tissue systems pathology test to predict progression in patients with Barrett’s esophagus. Am J Gastroenterol 2020;115:843–852.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Singh S, Manickam P, Amin AV et al. Incidence of esophageal adenocarcinoma in Barrett’s esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc 2014;79:897-909 e4; quiz 983 e1, 983 e3.

    Article  PubMed  Google Scholar 

  39. Duits LC, Phoa KN, Curvers WL et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 2015;64:700–706.

    Article  PubMed  Google Scholar 

  40. Standards of Practice C, Wani S, Qumseya B, et al. Endoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc 2018;87:907–931 e9.

  41. van der Wel MJ, Coleman HG, Bergman J et al. Histopathologist features predictive of diagnostic concordance at expert level among a large international sample of pathologists diagnosing Barrett’s dysplasia using digital pathology. Gut 2020;69:811–822.

    Article  PubMed  Google Scholar 

  42. Sharma P, Shaheen NJ, Katzka D et al. AGA clinical practice update on endoscopic treatment of Barrett’s esophagus with dysplasia and/or early cancer: expert review. Gastroenterology 2020;158:760–769.

    Article  PubMed  Google Scholar 

  43. Pollit V, Graham D, Leonard C et al. A cost-effectiveness analysis of endoscopic eradication therapy for management of dysplasia arising in patients with Barrett’s oesophagus in the United Kingdom. Curr Med Res Opin 2019;35:805–815.

    Article  PubMed  Google Scholar 

  44. Barret M, Pioche M, Terris B et al. Endoscopic radiofrequency ablation or surveillance in patients with Barrett’s oesophagus with confirmed low-grade dysplasia: a multicentre randomised trial. Gut 2021;70:1014–1022.

    Article  CAS  PubMed  Google Scholar 

  45. Krishnamoorthi R, Mohan BP, Jayaraj M et al. Risk of progression in Barrett’s esophagus indefinite for dysplasia: a systematic review and meta-analysis. Gastroint Endosc 2020;91:3-10.e3.

    Article  Google Scholar 

  46. Phillips R, Januszewicz W, Pilonis ND et al. The risk of neoplasia in patients with Barrett’s esophagus indefinite for dysplasia: a multicenter cohort study. Gastrointest Endosc 2021;94:263-270 e2.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Dunbar KB, Spechler SJ. The risk of lymph-node metastases in patients with high-grade dysplasia or intramucosal carcinoma in Barrett’s esophagus: a systematic review. Am J Gastroenterol 2012;107:850–62; quiz 863.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Wani S, Drahos J, Cook MB et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc 2014;79:224-232.e1.

    Article  PubMed  Google Scholar 

  49. Qumseya BJ, Bartel MJ, Gendy S et al. High rate of over-staging of Barrett’s neoplasia with endoscopic ultrasound: Systemic review and meta-analysis. Dig Liver Dis 2018;50:438–445.

    Article  PubMed  Google Scholar 

  50. Badreddine RJ, Prasad GA, Lewis JT et al. Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma. Clin Gastroenterol Hepatol 2010;8:248–253.

    Article  PubMed  Google Scholar 

  51. Leers JM, DeMeester SR, Oezcelik A et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg 2011;253:271–278.

    Article  PubMed  Google Scholar 

  52. Othman MO, Lee JH, Wang K. Clinical practice update on the utility of endoscopic submucosal dissection in T1b esophageal cancer: expert review. Clin Gastroenterol Hepatol 2019;17:2161–2166.

    Article  PubMed  Google Scholar 

  53. Manner H, Pech O, Heldmann Y et al. Efficacy, safety, and long-term results of endoscopic treatment for early stage adenocarcinoma of the esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol 2013;11:630–5; quiz e45.

    Article  PubMed  Google Scholar 

  54. Manner H, Pech O, Heldmann Y et al. The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc 2015;29:1888–1896.

    Article  PubMed  Google Scholar 

  55. Otaki F, Ma GK, Krigel A et al. Outcomes of patients with submucosal (T1b) esophageal adenocarcinoma: a multicenter cohort study. Gastrointest Endosc 2020;92:31-39 e1.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Shimamura Y, Iwaya Y, Kobayashi R et al. Clinical and pathological predictors of failure of endoscopic therapy for Barrett’s related high-grade dysplasia and early esophageal adenocarcinoma. Surg Endosc 2020;35:1–12.

    Google Scholar 

  57. Qumseya BJ, Wani S, Desai M et al. Adverse events after radiofrequency ablation in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016;14:1086-1095 e6.

    Article  PubMed  Google Scholar 

  58. Belghazi K, Marcon N, Teshima C et al. Risk factors for serious adverse events associated with multiband mucosectomy in Barrett’s esophagus: an international multicenter analysis of 3827 endoscopic resection procedures. Gastrointest Endosc 2020;92:259-268 e2.

    Article  PubMed  Google Scholar 

  59. Desai M, Saligram S, Gupta N et al. Efficacy and safety outcomes of multimodal endoscopic eradication therapy in Barrett’s esophagus-related neoplasia: a systematic review and pooled analysis. Gastrointest Endosc 2017;85:482-495.e4.

    Article  PubMed  Google Scholar 

  60. Wolf WA, Pasricha S, Cotton C et al. Incidence of esophageal adenocarcinoma and causes of mortality after radiofrequency ablation of Barrett’s esophagus. Gastroenterology 2015;149:1752-1761 e1.

    Article  PubMed  Google Scholar 

  61. Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009;360:2277–2288.

    Article  CAS  PubMed  Google Scholar 

  62. Phoa KN, van Vilsteren FG, Weusten BL et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014;311:1209–1217.

    Article  CAS  PubMed  Google Scholar 

  63. Pouw RE, Klaver E, Phoa KN et al. Radiofrequency ablation for low-grade dysplasia in Barrett’s esophagus: long-term outcome of a randomized trial. Gastrointest Endosc 2020;92:569–574.

    Article  PubMed  Google Scholar 

  64. Pandey G, Mulla M, Lewis WG et al. Systematic review and meta-analysis of the effectiveness of radiofrequency ablation in low grade dysplastic Barrett’s esophagus. Endoscopy 2018;50:953–960.

    Article  PubMed  Google Scholar 

  65. Yang LS, Holt BA, Williams R, et al. Endoscopic features of buried Barrett's mucosa. Gastrointest Endosc 2020;94:14–21.

  66. Manner H, Rabenstein T, Pech O et al. Ablation of residual Barrett’s epithelium after endoscopic resection: a randomized long-term follow-up study of argon plasma coagulation vs surveillance (APE study). Endoscopy 2014;46:6–12.

    PubMed  Google Scholar 

  67. Peerally MF, Bhandari P, Ragunath K et al. Radiofrequency ablation compared with argon plasma coagulation after endoscopic resection of high-grade dysplasia or stage T1 adenocarcinoma in Barrett’s esophagus: a randomized pilot study (BRIDE). Gastrointest Endosc 2019;89:680–689.

    Article  PubMed  Google Scholar 

  68. Wronska E, Polkowski M, Orlowska J et al. Argon plasma coagulation for Barrett’s esophagus with low-grade dysplasia: a randomized trial with long-term follow-up on the impact of power setting and proton pump inhibitor dose. Endoscopy 2021;53:123–132.

    Article  PubMed  Google Scholar 

  69. Manner H, Neugebauer A, Scharpf M et al. The tissue effect of argon-plasma coagulation with prior submucosal injection (Hybrid-APC) versus standard APC: a randomized ex-vivo study. United Eur Gastroenterol J 2014;2:383–390.

    Article  Google Scholar 

  70. Kolb JM, Shah S, Chahine A, et al. Hybrid argon plasma coagulation for Barrett’s esophagus. VideoGIE 2021.

  71. Manner H, May A, Kouti I et al. Efficacy and safety of Hybrid-APC for the ablation of Barrett’s esophagus. Surg Endosc 2016;30:1364–1370.

    Article  PubMed  Google Scholar 

  72. Mohan BP, Krishnamoorthi R, Ponnada S, et al. Liquid nitrogen spray cryotherapy in treatment of Barrett's esophagus, where do we stand? A systematic review and meta-analysis. Dis Esophagus 2019. https://doi.org/10.1093/dote/doy130.

  73. Canto MI, Trindade AJ, Abrams J et al. Multifocal cryoballoon ablation for eradication of Barrett’s esophagus-related neoplasia: a prospective multicenter clinical trial. Am J Gastroenterol 2020;115:1879–1890.

    Article  PubMed  Google Scholar 

  74. van Munster SN, Pouw RE, Sharma VK et al. Radiofrequency vapor ablation for Barrett’s esophagus: feasibility, safety and proof of concept in a stepwise study with in vitro, animal, and the first in-human application. Endoscopy 2020;53:1162–1168.

    PubMed  Google Scholar 

  75. Yang D, Othman M, Draganov PV. Endoscopic mucosal resection vs endoscopic submucosal dissection For Barrett’s esophagus and colorectal neoplasia. Clin Gastroenterol Hepatol 2019;17:1019–1028.

    Article  PubMed  Google Scholar 

  76. Draganov PV, Wang AY, Othman MO et al. AGA institute clinical practice update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019;17:16-25 e1.

    Article  PubMed  Google Scholar 

  77. Terheggen G, Horn EM, Vieth M et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett’s neoplasia. Gut 2017;66:783–793.

    Article  PubMed  Google Scholar 

  78. Codipilly DC, Dhaliwal L, Oberoi M et al. Comparative outcomes of cap assisted endoscopic resection and endoscopic submucosal dissection in dysplastic Barrett’s esophagus. Clin Gastroenterol Hepatol 2020;20:65-73 e1.

    Article  PubMed  Google Scholar 

  79. Yang D, Zou F, Xiong S et al. Endoscopic submucosal dissection for early Barrett’s neoplasia: a meta-analysis. Gastrointest Endosc 2018;87:1383–1393.

    Article  PubMed  Google Scholar 

  80. Tomizawa Y, Friedland S, Hwang JH. Endoscopic submucosal dissection (ESD) for Barrett’s esophagus (BE)-related early neoplasia after standard endoscopic management is feasible and safe. Endoscopy Int Open 2020;08:E498–E505.

    Article  Google Scholar 

  81. Kahn A, Shaheen NJ, Iyer PG. Approach to the post-ablation Barrett’s esophagus patient. Am J Gastroenterol 2020;115:823–831.

    Article  PubMed  Google Scholar 

  82. Cotton CC, Haidry R, Thrift AP et al. Development of evidence-based surveillance intervals after radiofrequency ablation of Barrett’s esophagus. Gastroenterology 2018;155:316-326 e6.

    Article  PubMed  Google Scholar 

  83. Cotton CC, Wolf WA, Overholt BF et al. Late recurrence of Barrett’s esophagus after complete eradication of intestinal metaplasia is rare: final report from Ablation In Intestinal Metaplasia containing dysplasia trial. Gastroenterology 2017;153:681-688 e2.

    Article  PubMed  Google Scholar 

  84. Sawas T, Iyer PG, Alsawas M et al. Higher rate of barrett’s detection in the first year after successful endoscopic therapy: meta-analysis. Am J Gastroenterol 2018;113:959–971.

    Article  PubMed  Google Scholar 

  85. Wani S, Han S, Kushnir V et al. Recurrence is rare following complete eradication of intestinal metaplasia in patients with Barrett’s esophagus and peaks at 18 months. Clin Gastroenterol Hepatol 2020;18:2609-2617 e2.

    Article  PubMed  Google Scholar 

  86. Omar M, Thaker AM, Wani S et al. Anatomic location of Barrett’s esophagus recurrence after endoscopic eradication therapy: development of a simplified surveillance biopsy strategy. Gastrointest Endosc 2019;90:395–403.

    Article  PubMed  Google Scholar 

  87. Sami SS, Ravindran A, Kahn A et al. Timeline and location of recurrence following successful ablation in Barrett’s oesophagus: an international multicentre study. Gut 2019;68:1379–1385.

    Article  PubMed  Google Scholar 

  88. Solfisburg QS, Sami SS, Gabre J et al. Clinical significance of recurrent gastroesophageal junction intestinal metaplasia after endoscopic eradication of Barrett’s esophagus. Gastrointest Endosc 2021;93:1250-1257 e3.

    Article  PubMed  Google Scholar 

  89. Eluri S, Paterson A, Lauren BN, et al. Utility and cost-effectiveness of a nonendoscopic approach to barrett's esophagus surveillance after endoscopic therapy. Clin Gastroenterol Hepatol 2022;20:e51–e63.

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Kolb, J.M., Wani, S. Endoscopic Management of Barrett's Esophagus. Dig Dis Sci 67, 1469–1479 (2022). https://doi.org/10.1007/s10620-022-07395-x

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