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Endoscopic Treatment of Early Barrett’s Neoplasia: Expanding Indications, New Challenges

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Stem Cells, Pre-neoplasia, and Early Cancer of the Upper Gastrointestinal Tract

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 908))

Abstract

Endoscopic therapy of early Barrett’s neoplasia is nowadays the treatment of choice and recommended over surgery in most current guidelines. Recent data suggest radiofrequency ablation of low-grade intraepithelial neoplasia when confirmed by an expert pathologist. Endoscopic therapy of high-grade intraepithelial neoplasia and mucosal Barrett’s adenocarcinoma consists of two steps: first endoscopic resection of all visible lesions, and second ablation of the remaining flat Barrett’s mucosa to reduce the rate of recurrences and metachronous neoplasia. The preferred ablation method is radiofrequency ablation. In case of Barrett’s adenocarcinoma with incipient submucosal invasion, endoscopic treatment can be considered curative when there are no further risk factors present.

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References

  1. Bennett C, Vakil N, Bergman J, et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma. Based on a Delphi process. Gastroenterology. 2012;143(2):336–46.

    Article  PubMed  Google Scholar 

  2. Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S, Schepp W, Wenzl TG. Mitarbeiter der Leitliniengruppe.S2k-Leitlinie: Gastroösophageale Refluxkrankheit unter Federführung der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten. Z Gastroenterol. 2014;52(11):1299–346.

    Article  PubMed  Google Scholar 

  3. Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O’Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J, British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63(1):7–42.

    Article  PubMed  Google Scholar 

  4. Inoue H, Endo M. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope. Surg Endosc. 1993;6:264–5.

    Article  Google Scholar 

  5. Pech O, May A, Rabenstein T, Ell C. Endoscopic resection of early oesophageal cancer. Gut. 2007;56:1625–34.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pech O, May A, Manner H, et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology. 2014;146(3):652–60.

    Article  PubMed  Google Scholar 

  7. Höbel S, Dautel P, Baumbach R, Oldhafer KJ, Stang A, Feyerabend B, Yahagi N, Schrader C, Faiss S. Single center experience of endoscopic submucosal dissection (ESD) in early Barrett’s adenocarcinoma. Surg Endosc. 2015;29(6):1591–7.

    Article  PubMed  Google Scholar 

  8. Neuhaus H, Terheggen G, Rutz EM, Vieth M, Schumacher B. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy. 2012;44(12):1105–13.

    Article  CAS  PubMed  Google Scholar 

  9. Probst A, Aust D, Märkl B, Anthuber M, Messmann H. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy. 2015;47(2):113–21.

    PubMed  Google Scholar 

  10. Gossner L, Stolte M, Sroka R, et al. Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid. Gastroenterology. 1998;114:448–55.

    Article  CAS  PubMed  Google Scholar 

  11. Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barrett´s esophagus: follow-up in 100 patients. Gastrointest Endosc. 1999;49:1–7.

    Article  CAS  PubMed  Google Scholar 

  12. Pech O, Gossner L, May A, et al. Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett’s cancer and high-grade intraepithelial neoplasia. Gastrointest Endosc. 2005;62:24–30.

    Article  PubMed  Google Scholar 

  13. Overholt BF, Lightdale CJ, Wang KK, Canto MI, Burdick S, Haggitt RC, Bronner MP, Taylor SL, Grace MG, Depot M. Photodynamic therapy with porfimer sodium for ablation of high-grade dysplasia in Barrett’s esophagus: international, partially blinded, randomized phase III trial. Gastrointest Endosc. 2005;62(4):488–98.

    Article  PubMed  Google Scholar 

  14. Overholt BF, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak Jr MV, Nishioka N, Barr H, Marcon N, Pedrosa M, Bronner MP, Grace M, Depot M. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66(3):460–8.

    Article  PubMed  Google Scholar 

  15. Bronner MP, Overholt BF, Taylor SL, Haggitt RC, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak MV, Nishioka N, Barr H, Canto MI, Marcon N, Pedrosa M, Grace M, Depot M. Squamous overgrowth is not a safety concern for photodynamic therapy for Barrett’s esophagus with high-grade dysplasia. Gastroenterology. 2009;136(1):56–64.

    Article  PubMed  Google Scholar 

  16. Yachimski P, Puricelli WP, Nishioka NS. Patient predictors of esophageal stricture development after photodynamic therapy. Clin Gastroenterol Hepatol. 2008;6(3):302–8.

    Article  PubMed  Google Scholar 

  17. Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Lutzke LS, Borkenhagen LS. Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett’s esophagus. Gastrointest Endosc. 2007;65(1):60–6.

    Article  PubMed  Google Scholar 

  18. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277–88.

    Article  CAS  PubMed  Google Scholar 

  19. Gupta M, Iyer PG, Lutzke L, et al. Recurrence of esophageal intestinal metaplasia after endoscopic mucosal resection and radiofrequency ablation of Barrett’s esophagus: results from a US Multicenter Consortium. Gastroenterology. 2013;145(1):79–86.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Haidry RJ, Dunn JM, Butt MA, et al. Radiofrequency ablation and endoscopic mucosal resection for dysplastic barrett’s esophagus and early esophageal adenocarcinoma: outcomes of the UK National Halo RFA Registry. Gastroenterology. 2013;145(1):87–95.

    Article  PubMed  Google Scholar 

  21. Phoa KN, Pouw RE, Bisschops R, Pech O, Ragunath K, Weusten BL, 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 JJ. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of an European multicentre study (EURO-II). Gut. 2015. pii: gutjnl-2015-309298. doi: 10.1136/gutjnl-2015-309298. [Epub ahead of print].

    Google Scholar 

  22. Shaheen NJ, Greenwald BD, Peery AF, Dumot JA, Nishioka NS, Wolfsen HC, Burdick JS, Abrams JA, Wang KK, Mallat D, Johnston MH, Zfass AM, Smith JO, Barthel JS, Lightdale CJ. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71(4):680–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dumot JA, Vargo 2nd JJ, Falk GW, Frey L, Lopez R, Rice TW. An open-label, prospective trial of cryospray ablation for Barrett’s esophagus high-grade dysplasia and early esophageal cancer in high-risk patients. Gastrointest Endosc. 2009;70(4):635–44.

    Article  PubMed  Google Scholar 

  24. Gosain S, Mercer K, Twaddell WS, Uradomo L, Greenwald BD. Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc. 2013;78(2):260–5.

    Article  PubMed  Google Scholar 

  25. Attwood SE, Lewis CJ, Caplin S, et al. Argon beam plasma coagulation as therapy for high-grade dysplasia in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2003;1:258–63.

    Article  PubMed  Google Scholar 

  26. Ragunath K, Krasner N, Raman VS, et al. Endoscopic ablation of dysplastic Barrett’s oesophagus comparing argon plasma coagulation and photodynamic therapy: a randomized prospective trial assessing efficacy and cost-effectiveness. Scand J Gastroenterol. 2005;40:750–8.

    Article  PubMed  Google Scholar 

  27. Pech O, Behrens A, May AD, et al. Long-Term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57(9):1200–6.

    Article  CAS  PubMed  Google Scholar 

  28. 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(5):383–90.

    Article  Google Scholar 

  29. Manner H, Rabenstein T, Braun K, et al. What should we do with the remainder of the Barrett’s segment after endoscopic resection of early Barrett’s cancer? Intermediate results of the first prospective-randomized trial on the APC ablation of residual Barrett’s mucosa with concomitant esomeprazole therapy versus surveillance without ablation after ER of early Barrett’s cancer. Endoscopy. 2014;46(1):6–12.

    PubMed  Google Scholar 

  30. Milashka M, Calomme A, Van Laethem JL, et al. Sixteen-year follow-up of Barrett’s esophagus, endoscopically treated with argon plasma coagulation. United Eur Gastroenterol J. 2014;2(5):367–73.

    Article  Google Scholar 

  31. Curvers WL, ten Kate FJ, Krishnadath KK, Visser M, Elzer B, Baak LC, Bohmer C, Mallant-Hent RC, van Oijen A, Naber AH, Scholten P, Busch OR, Blaauwgeers HG, Meijer GA, Bergman JJ. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol. 2010;105(7):1523–30.

    Article  PubMed  Google Scholar 

  32. Duits LC, Phoa KN, Curvers WL, Ten Kate FJ, Meijer GA, Seldenrijk CA, Offerhaus GJ, Visser M, Meijer SL, Krishnadath KK, Tijssen JG, Mallant-Hent RC, Bergman JJ. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut. 2015;64(5):700–6.

    Article  PubMed  Google Scholar 

  33. Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, Fullarton G, Di Pietro M, Ravi N, Visser M, Offerhaus GJ, Seldenrijk CA, Meijer SL, ten Kate FJ, Tijssen JG, Bergman JJ. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12):1209–17.

    Article  CAS  PubMed  Google Scholar 

  34. Buskens CJ, Westerterp M, Lagarde SM, Bergman JJ, ten Kate FJ, van Lanschot JJ. Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc. 2004;60:703–10.

    Article  PubMed  Google Scholar 

  35. Stein HJ, Feith M, Bruecher BLDM, Nahrig J, Siewert JR. Early esophageal squamous cell and adenocarcinoma: pattern of lymphatic spread and prognostic factors for long term survival after surgical resection. Ann Surg. 2005;242:566–73.

    PubMed  PubMed Central  Google Scholar 

  36. Rice TW, Blackstone EH, Goldblum JR, DeCamp MM, Murthy SC, Falk GW, Ormsby AH, Rybicki LA, Richter JE, Adelstein DJ. Superficial adenocarcinoma of the esophagus. J Thorac Cardiovasc Surg. 2001;122:1077–90.

    Article  CAS  PubMed  Google Scholar 

  37. Oh DS, Hagen JA, Chandrasoma PT, Dunst CM, Demeester SR, Alavi M, Bremner CG, Lipham J, Rizzetto C, Cote R, Demeester TR. Clinical biology and surgical therapy of intramucosal adenocarcinoma of the esophagus. J Am Coll Surg. 2006;203:152–61.

    Article  PubMed  Google Scholar 

  38. Bollschweiler E, Baldus SE, Schröder W, Prenzel K, Gutschow C, Schneider PM, Hölscher AH. High rate of lymph-node metastasis in submucosal esophageal squamous-cell carcinomas and adenocarcinomas. Endoscopy. 2006;38:149–56.

    Article  CAS  PubMed  Google Scholar 

  39. Ancona E, Rampado S, Cassaro M, Battaglia G, Ruol A, Castoro C, Portale G, Cavallin F, Rugge M. Prediction of lymph node status in superficial esophageal carcinoma. Ann Surg Oncol. 2008;15(11):3278–88.

    Article  PubMed  Google Scholar 

  40. Manner H, May A, Pech O, Gossner L, Rabenstein T, Günter E, Vieth M, Stolte M, Ell C. Early Barrett’s carcinoma with “low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol. 2008;103(10):2589–97.

    Article  PubMed  Google Scholar 

  41. Badreddine RJ, Prasad GA, Lewis JT, Lutzke LS, Borkenhagen LS, Dunagan KT, Wang KK. Depth of submucosal invasion does not predict lymph node metastasis and survival of patients with esophageal carcinoma. Clin Gastroenterol Hepatol. 2010;8(3):248–53.

    Article  PubMed  Google Scholar 

  42. Manner H, Pech O, Heldmann Y, May A, Pohl J, Behrens A, Gossner L, Stolte M, Vieth M, Ell C. Efficiacy, safety and long-term results of endoscopic treatment for early-stage adenocarcinoma oft he esophagus with low-risk sm1 invasion. Clin Gastroenterol Hepatol. 2013;11(6):630–5.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital Regensburg, Teaching Hospital of the University of Regensburg, Pruefeninger Str. 86, Regensburg, D-93049, Germany

    Oliver Pech M.D., Ph.D.

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  1. Oliver Pech M.D., Ph.D.
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Correspondence to Oliver Pech M.D., Ph.D. .

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Editors and Affiliations

  1. UCL Cancer Institute, University College London, London, United Kingdom

    Marnix Jansen

  2. Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, United Kingdom

    Nicholas A. Wright

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Pech, O. (2016). Endoscopic Treatment of Early Barrett’s Neoplasia: Expanding Indications, New Challenges. In: Jansen, M., Wright, N. (eds) Stem Cells, Pre-neoplasia, and Early Cancer of the Upper Gastrointestinal Tract. Advances in Experimental Medicine and Biology, vol 908. Springer, Cham. https://doi.org/10.1007/978-3-319-41388-4_6

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