Dysplasia and early neoplasia in Barrett's oesophagus

Diagnosis and Endoscopic Management of Barrett's Esophagus: an Italian Experts' Opinion based document

BACKGROUND

Barrett's esophagus (BE) is recognized as a risk factor for esophageal adenocarcinoma. An expert panel was organized in Italy with the aim of drafting a series of statements on BE to guide diagnosis and management of patients with BE.

METHODS

The working Group Coordinators worked on a literature search to identify key topics regarding critical steps of the endoscopic approach to BE. Based on the search and their expert opinion, a list of most meaningful questions was prepared and emailed to all members who were asked to vote the questions. When the survey was completed a consensus meeting was organized. According to the survey results, Group Coordinators proposed a draft statement that was voted. By definition, the statement was formulated when there was an agreement of ≥50% among participants.

RESULTS

Twenty nine participants deliberated 18 questions. The agreement was reached for 16 questions for which a recommendation was formulated.

CONCLUSION

The generated statements highlight the Italian contribution to the European Position Statement of the European Society of Gastrointestinal Endoscopy. The Italian statements preserve peculiarities when dealing with the endoscopic management of BE and wishes to be considered as a contribution for the care of BE patients even with a low risk of progression to esophageal neoplasia.

Early metal stent insertion fails to prevent stricturing after single-stage complete Barrett's excision for high-grade dysplasia and early cancer

BACKGROUND

Barrett's esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) can be effectively treated by single-session EMR, resulting in complete Barrett's excision (CBE). CBE provides accurate histology for staging and clinical confirmation of neoplasia eradication but is limited by a high risk of esophageal stricture formation.

OBJECTIVE

To evaluate the effectiveness of prophylactic temporary esophageal stenting to prevent post-CBE stricture formation.

DESIGN AND SETTING

Single-center, investigator-initiated feasibility study.

PATIENTS

Circumferential, short-segment Barrett's esophagus (≤C3≤M5) with HGD or IMC.

INTERVENTION

Single-stage CBE and insertion of a fully covered metal esophageal stent at 10 days that was removed at 8 weeks. Patients were followed for a minimum of 2 surveillance endoscopies.

MAIN OUTCOME MEASUREMENT

Symptomatic esophageal stricture formation.

RESULTS

At the end of the follow-up period, 8 patients (57.1%) required esophageal dilation for symptomatic CBE-related (n = 7) or stent-related (n = 4) strictures. A median of 3 surveillance endoscopies were performed over a median endoscopic follow-up of 17 months (range 4-25 months). Single-stage CBE successfully eliminated Barrett's intestinal metaplasia and neoplasia in 71.4% and 92.9% of patients, respectively. Four patients were admitted to the hospital, and 4 patients had early stent removal because of pain or dysphagia.

LIMITATIONS

Single-center feasibility study.

CONCLUSIONS

In a prospective study evaluating prophylactic esophageal stent insertion after single-stage CBE, esophageal strictures formed in more than of half the study cohort, and stents were associated with significant morbidity. An alternative method to reduce stricture formation is required. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT01554280.).