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Endoscopic Management of Barrett’s Esophagus

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Diagnostic and Therapeutic Procedures in Gastroenterology

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Barrett’s esophagus (BE) is known to be a precursor for esophageal adenocarcinoma (EAC). Endoscopic screening and surveillance are developed to identify changes (dysplasia) in the mucosa, which can lead to the development of EAC. In this chapter we discuss various methods used in the diagnosis and surveillance of BE and also the role of endoscopic ultrasound, endoscopic mucosal resection and dissection, and other therapies used in BE.

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References

  1. Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2015;111(1):30–50.

    Article  PubMed  Google Scholar 

  2. Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 2011;106:1447–55. quiz 1456.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rubenstein JH, Mattek N, Eisen G. Age- and sex-specific yield of Barrett’s esophagus by endoscopy indication. Gastrointest Endosc. 2010;71:21–7.

    Article  PubMed  Google Scholar 

  4. Singh S, Sharma AN, Murad MH, et al. Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11:1399–1412 e7.

    Article  PubMed  Google Scholar 

  5. Rubenstein JH, Morgenstern H, Appelman H, et al. Prediction of Barrett’s esophagus among men. Am J Gastroenterol. 2013;108:353–62.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brown LM, Devesa SS. Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin N Am. 2002;11:235–56.

    Article  PubMed  Google Scholar 

  7. Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer. 2013;119:1149–58.

    Article  PubMed  Google Scholar 

  8. 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;131:1392–9.

    Article  PubMed  Google Scholar 

  9. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.

    Article  PubMed  Google Scholar 

  10. Eloubeidi MA, Provenzale D. Does this patient have Barrett’s esophagus? The utility of predicting Barrett’s esophagus at the index endoscopy. Am J Gastroenterol. 1999;94:937–43.

    Article  CAS  PubMed  Google Scholar 

  11. Kim SL, Waring JP, Spechler SJ, et al. Diagnostic inconsistencies in Barrett’s esophagus Department of Veterans Affairs Gastroesophageal Reflux Study Group. Gastroenterology. 1994;107:945–9.

    Article  CAS  PubMed  Google Scholar 

  12. Sharma P. Narrow band imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2005;3:S21–2.

    Article  PubMed  Google Scholar 

  13. Kuznetsov K, Lambert R, Rey JF. Narrow-band imaging: potential and limitations. Endoscopy. 2006;38:76–81.

    Article  CAS  PubMed  Google Scholar 

  14. Kara MA, Ennahachi M, Fockens P, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–66.

    Article  PubMed  Google Scholar 

  15. Reddymasu SC, Sharma P. Advances in endoscopic imaging of the esophagus. Gastroenterol Clin N Am. 2008;37:763–74. vii.

    Article  Google Scholar 

  16. Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61:970–6.

    Article  PubMed  Google Scholar 

  17. 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 

  18. Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001;32:368–78.

    Article  CAS  PubMed  Google Scholar 

  19. Wani S, Falk GW, Post J, et al. Risk factors for progression of low-grade dysplasia in patients with Barrett’s esophagus. Gastroenterology. 2011;141:1179–1186 e1.

    Article  PubMed  Google Scholar 

  20. Committee ASoP, Evans JA, Early DS, et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76:1087–94.

    Article  Google Scholar 

  21. De Looze D. Endoscopic follow-up of Barrett’s esophagus: protocol and implications. Acta Gastroenterol Belg. 2000;63:29–35.

    PubMed  Google Scholar 

  22. Sturm MB, Wang TD. Emerging optical methods for surveillance of Barrett’s oesophagus. Gut. 2015;64:1816–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Committee AT, Kwon RS, Adler DG, et al. High-resolution and high-magnification endoscopes. Gastrointest Endosc. 2009;69:399–407.

    Article  Google Scholar 

  24. Corley DA, Mehtani K, Quesenberry C, et al. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology. 2013;145:312–9 e1.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Enestvedt BK, Lugo R, Guarner-Argente C, et al. Location, location, location: does early cancer in Barrett’s esophagus have a preference? Gastrointest Endosc. 2013;78:462–7.

    Article  PubMed  Google Scholar 

  26. Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013;11:1562–70 e1-2.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Song J, Zhang J, Wang J, et al. Meta-analysis of the effects of endoscopy with narrow band imaging in detecting dysplasia in Barrett’s esophagus. Dis Esophagus. 2015;28:560–6.

    Article  CAS  PubMed  Google Scholar 

  28. Committee AT, Thosani N, Abu Dayyeh BK, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE preservation and incorporation of valuable endoscopic innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc. 2016;83:684–698 e7.

    Article  Google Scholar 

  29. Boerwinkel DF, Holz JA, Aalders MC, et al. Third-generation autofluorescence endoscopy for the detection of early neoplasia in Barrett’s esophagus: a pilot study. Dis Esophagus. 2014;27:276–84.

    Article  CAS  PubMed  Google Scholar 

  30. Cobb MJ, Hwang JH, Upton MP, et al. Imaging of subsquamous Barrett’s epithelium with ultrahigh-resolution optical coherence tomography: a histologic correlation study. Gastrointest Endosc. 2010;71:223–30.

    Article  PubMed  Google Scholar 

  31. Wolfsen HC, Sharma P, Wallace MB, et al. Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos). Gastrointest Endosc. 2015;82:631–40.

    Article  PubMed  Google Scholar 

  32. Schmassmann A. Esophageal carcinoma: accurate staging thanks to modern diagnostic methods open up new therapeutic strategies. Schweiz Med Wochenschr. 1999;129:1207–10.

    CAS  PubMed  Google Scholar 

  33. Ziegler K, Sanft C, Zeitz M, et al. Evaluation of endosonography in TN staging of oesophageal cancer. Gut. 1991;32:16–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Nijhawan PK, Wang KK. Endoscopic mucosal resection for lesions with endoscopic features suggestive of malignancy and high-grade dysplasia within Barrett’s esophagus. Gastrointest Endosc. 2000;52:328–32.

    Article  CAS  PubMed  Google Scholar 

  35. Larghi A, Lightdale CJ, Memeo L, et al. EUS followed by EMR for staging of high-grade dysplasia and early cancer in Barrett’s esophagus. Gastrointest Endosc. 2005;62:16–23.

    Article  PubMed  Google Scholar 

  36. Griffin SM, Burt AD, Jennings NA. Lymph node metastasis in early esophageal adenocarcinoma. Ann Surg. 2011;254:731–6. discussion 736–7.

    Article  CAS  PubMed  Google Scholar 

  37. Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg. 2009;87:1048–54. discussion 1054–5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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;253:271–8.

    Article  PubMed  Google Scholar 

  39. Pech O, Behrens A, May A, 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;57:1200–6.

    Article  CAS  PubMed  Google Scholar 

  40. Stahl M, Budach W, Meyer HJ, et al. Esophageal cancer: clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v46–9.

    Article  PubMed  Google Scholar 

  41. May A, Ell C. Diagnosis and treatment of early esophageal cancer. Curr Opin Gastroenterol. 2006;22:433–6.

    Article  PubMed  Google Scholar 

  42. Ciocirlan M, Lapalus MG, Hervieu V, et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy. 2007;39:24–9.

    Article  CAS  PubMed  Google Scholar 

  43. Ell C, May A, Pech O, et al. Curative endoscopic resection of early esophageal adenocarcinomas (Barrett’s cancer). Gastrointest Endosc. 2007;65:3–10.

    Article  PubMed  Google Scholar 

  44. Sepesi B, Watson TJ, Zhou D, et al. Are endoscopic therapies appropriate for superficial submucosal esophageal adenocarcinoma? An analysis of esophagectomy specimens. J Am Coll Surg. 2010;210:418–27.

    Article  PubMed  Google Scholar 

  45. Manner H, May A, Pech O, et al. Early Barrett’s carcinoma with “low-risk” submucosal invasion: long-term results of endoscopic resection with a curative intent. Am J Gastroenterol. 2008;103:2589–97.

    Article  PubMed  Google Scholar 

  46. 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. 2016;66(5):783–93.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Overholt BF, Lightdale CJ, Wang KK, et al. 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;62:488–98.

    Article  PubMed  Google Scholar 

  48. Overholt BF, Wang KK, Burdick JS, et al. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66:460–8.

    Article  PubMed  Google Scholar 

  49. Ganz RA, Utley DS, Stern RA, et al. Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus. Gastrointest Endosc. 2004;60:1002–10.

    Article  PubMed  Google Scholar 

  50. Smith CD, Bejarano PA, Melvin WS, et al. Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system. Surg Endosc. 2007;21:560–9.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  52. Fleischer DE, Overholt BF, Sharma VK, et al. Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc. 2008;68:867–76.

    Article  PubMed  Google Scholar 

  53. 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;145:79–86. e1.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Small AJ, Sutherland SE, Hightower JS, et al. Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett’s esophagus. Gastrointest Endosc. 2015;81:1158–66 e1-4.

    Article  PubMed  Google Scholar 

  55. Shaheen NJ, Greenwald BD, Peery AF, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71:680–5.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Ghorbani S, Tsai FC, Greenwald BD, et al. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s dysplasia: results of the National Cryospray Registry. Dis Esophagus. 2015;29(3):241–7.

    Article  PubMed  Google Scholar 

  57. 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 

  58. Sie C, Bright T, Schoeman M, et al. Argon plasma coagulation ablation versus endoscopic surveillance of Barrett’s esophagus: late outcomes from two randomized trials. Endoscopy. 2013;45:859–65.

    Article  PubMed  Google Scholar 

  59. Manner H, May A, Kouti I, et al. Efficacy and safety of hybrid-APC for the ablation of Barrett’s esophagus. Surg Endosc. 2016;30:1364–70.

    Article  PubMed  Google Scholar 

  60. Tomizawa Y, Iyer PG, Wong Kee Song LM, et al. Safety of endoscopic mucosal resection for Barrett’s esophagus. Am J Gastroenterol. 2013;108:1440–7. quiz 1448.

    Article  PubMed  Google Scholar 

  61. Fujishiro M, Kodashima S, Goto O, et al. Endoscopic submucosal dissection for esophageal squamous cell neoplasms. Dig Endosc. 2009;21:109–15.

    Article  PubMed  Google Scholar 

  62. Inoue H. Endoscopic mucosal resection for esophageal and gastric mucosal cancers. Can J Gastroenterol. 1998;12:355–9.

    Article  CAS  PubMed  Google Scholar 

  63. van Vilsteren FG, Pouw RE, Seewald S, et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut. 2011;60:765–73.

    Article  PubMed  Google Scholar 

  64. Seewald S, Akaraviputh T, Seitz U, et al. Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma. Gastrointest Endosc. 2003;57:854–9.

    Article  PubMed  Google Scholar 

  65. Qumseya B, Panossian AM, Rizk C, et al. Predictors of esophageal stricture formation post endoscopic mucosal resection. Clin Endosc. 2014;47:155–61.

    Article  PubMed  PubMed Central  Google Scholar 

  66. 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(8):1086–1095.e6.

    Article  PubMed  Google Scholar 

  67. Grade AJ, Shah IA, Medlin SM, et al. The efficacy and safety of argon plasma coagulation therapy in Barrett’s esophagus. Gastrointest Endosc. 1999;50:18–22.

    Article  CAS  PubMed  Google Scholar 

  68. Ackroyd R, Tam W, Schoeman M, et al. Prospective randomized controlled trial of argon plasma coagulation ablation vs. endoscopic surveillance of patients with Barrett’s esophagus after antireflux surgery. Gastrointest Endosc. 2004;59:1–7.

    Article  PubMed  Google Scholar 

  69. Van Laethem JL, Jagodzinski R, Peny MO, et al. Argon plasma coagulation in the treatment of Barrett’s high-grade dysplasia and in situ adenocarcinoma. Endoscopy. 2001;33:257–61.

    Article  PubMed  Google Scholar 

  70. American Society for Gastrointestinal Endoscopy Technology C. Mucosal ablation devices. Gastrointest Endosc. 2008;68:1031–42.

    Article  Google Scholar 

  71. Anders M, Bahr C, El-Masry MA, et al. Long-term recurrence of neoplasia and Barrett’s epithelium after complete endoscopic resection. Gut. 2014;63:1535–43.

    Article  PubMed  Google Scholar 

  72. Pasricha S, Bulsiewicz WJ, Hathorn KE, et al. Durability and predictors of successful radiofrequency ablation for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2014;12:1840–7 e1.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Chadwick G, Groene O, Taylor A, et al. Management of Barrett’s high-grade dysplasia: initial results from a population-based national audit. Gastrointest Endosc. 2016;83:736–742 e1.

    Article  PubMed  Google Scholar 

  74. Parasa S, Sharma P. Measuring quality of endoscopic eradication therapy in Barrett’s esophagus. Gastrointest Endosc. 2016;83:743–5.

    Article  PubMed  Google Scholar 

  75. Committee ASoP, Acosta RD, Abraham NS, et al. The management of antithrombotic agents for patients undergoing GI endoscopy. Gastrointest Endosc. 2016;83:3–16.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, KS, USA

    Taimur Khan MD & Prateek Sharma MD, FACP, FASGE

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  1. Taimur Khan MD
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  2. Prateek Sharma MD, FACP, FASGE
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Correspondence to Prateek Sharma MD, FACP, FASGE .

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Editors and Affiliations

  1. Advanced Endoscopy, Digestive Health Center, Section of Gastroenterology & Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA

    Subbaramiah Sridhar

  2. Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, Connecticut, USA

    George Y. Wu

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Khan, T., Sharma, P. (2018). Endoscopic Management of Barrett’s Esophagus. In: Sridhar, S., Wu, G. (eds) Diagnostic and Therapeutic Procedures in Gastroenterology. Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62993-3_6

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  • DOI: https://doi.org/10.1007/978-3-319-62993-3_6

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