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Tahara T, Shijimaya T, Yamazaki J, Tomiyama T, Fukui T, Naganuma M. Telomere Shortening of Barrett's Esophagus and Esophageal Adenocarcinoma in Japanese Patients. Cancer Invest 2023; 41:640-645. [PMID: 37548421 DOI: 10.1080/07357907.2023.2245897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
Telomere shortening is deeply involved in many types of cancer. Telomere length of esophageal adenocarcinoma (EAC) and Barrett's esophagus (BE) was examined in Japanese patients. Among BE from cancer free patients (Cancer free), BE from patients with EAC (Adjacent) and EAC tissue (Cancer), Cancer free group presented the longest telomeres, while Cancer group presented the shortest telomeres and Adjacent group presented intermediate telomeres. Direction of endoscopic biopsy, 2 o'clock direction was also significantly associated with shorter telomere length in non-neoplastic BE (p = 0.027). Shortened telomere highlighted the impact of this molecular change in early carcinogenesis in EAC.
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Affiliation(s)
- Tomomitsu Tahara
- Third department of internal medicine, Kansai Medical University, Hirakata, Japan
| | - Takuya Shijimaya
- Third department of internal medicine, Kansai Medical University, Hirakata, Japan
| | - Jumpei Yamazaki
- Translational Research Unit, Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- One Health Research Center, Hokkaido University, Sapporo, Japan
| | - Takashi Tomiyama
- Third department of internal medicine, Kansai Medical University, Hirakata, Japan
| | - Toshiro Fukui
- Third department of internal medicine, Kansai Medical University, Hirakata, Japan
| | - Makoto Naganuma
- Third department of internal medicine, Kansai Medical University, Hirakata, Japan
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Shijimaya T, Tahara T, Yamazaki J, Kobayashi S, Horitani A, Matsumoto Y, Nakamura N, Okazaki T, Takahashi Y, Tomiyama T, Honzawa Y, Fukata N, Fukui T, Naganuma M. Microarchitectures of Barrett's esophagus associated with DNA methylation status. Epigenomics 2023; 15:759-767. [PMID: 37661863 DOI: 10.2217/epi-2023-0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Aim: DNA methylation is involved in esophageal adenocarcinoma (EAC) and Barrett's esophagus (BE). Microarchitectures of on-neoplastic BE associated with DNA methylation status were examined using magnifying narrow-band imaging (NBI) endoscopy. Patients and methods: Using biopsies from non-neoplastic BE without cancer (n = 66; N group), with EAC (n = 27; ADJ group) and EAC tissue (n = 22; T group), methylation of N33, DPYS, SLC16A12, miR124a3 and miR34bc genes were quantified. Magnifying NBI features of non-neoplastic BE were classified according to their morphologies. Results: The ADJ and T groups presented higher DNA methylation compared with the N group. Magnifying NBI endoscopic features of non-neoplastic BE also correlated with DNA methylation as an independent factor. Conclusion: Microarchitectures of BE visualized by magnifying NBI endoscopy correlated with DNA methylation.
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Affiliation(s)
- Takuya Shijimaya
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Tomomitsu Tahara
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Jumpei Yamazaki
- Translational Research Unit, Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Japan
- One Health Research Center and Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Japan
| | - Sanshiro Kobayashi
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Anna Horitani
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Yasushi Matsumoto
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Naohiro Nakamura
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Takashi Okazaki
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Yu Takahashi
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Takashi Tomiyama
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Yusuke Honzawa
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Norimasa Fukata
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Toshiro Fukui
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
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3
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van der Ende-van Loon MCM, Stoker A, Nieuwkerk PT, Curvers WL, Schoon EJ. How are we measuring health-related quality of life in patients with a Barrett Esophagus? A systematic review on patient-reported outcome measurements. Qual Life Res 2021; 31:1639-1656. [PMID: 34748137 PMCID: PMC9098608 DOI: 10.1007/s11136-021-03009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
Purpose Barrett esophagus (BE) is associated with a significant decrease of health-related quality of life (HRQoL). Too often, patient-reported outcome measures (PROMs) are applied without considering what they measure and for which purposes they are suitable. With this systematic review, we provide researchers and physicians with an overview of all the instruments previously used for measuring HRQoL in BE patients and which PROMs are most appropriate from the patient’s perspective. Methods A comprehensive search was performed to identify all PROMs used for measuring HRQoL in BE patients, to identify factors influencing HRQoL according to BE patients, and to evaluate each PROM from a patients’ perspective. Results Among the 27 studies, a total of 32 different HRQoL instruments were identified. None of these instruments were designed or validated for use in BE patients. Four qualitative studies were identified exploring factors influencing HRQoL in the perceptions of BE patients. These factors included fear of cancer, anxiety, trust in physician, sense of control, uncertainty, worry, burden of endoscopy, knowledge and understanding, gastrointestinal symptoms, sleeping difficulties, diet and lifestyle, use of medication, and support of family and friends. Conclusion None of the quantitative studies measuring HRQoL in BE patients sufficiently reflected the perceptions of HRQoL in BE patients. Only gastrointestinal symptoms and anxiety were addressed in the majority of the studies. For the selection of PROMs, we encourage physicians and researchers measuring HRQoL to choose their PROMs from a patient perspective and not strictly based on health professionals’ definitions of what is relevant.
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Affiliation(s)
| | - A Stoker
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - P T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - W L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - E J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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4
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Abe K, Goda K, Kanamori A, Suzuki T, Yamamiya A, Takimoto Y, Arisaka T, Hoshi K, Sugaya T, Majima Y, Tominaga K, Iijima M, Hirooka S, Yamagishi H, Irisawa A. Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report. World J Gastrointest Surg 2021. [DOI: 10.4240/wjgs.v13.i10.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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5
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Abe K, Goda K, Kanamori A, Suzuki T, Yamamiya A, Takimoto Y, Arisaka T, Hoshi K, Sugaya T, Majima Y, Tominaga K, Iijima M, Hirooka S, Yamagishi H, Irisawa A. Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report. World J Gastrointest Surg 2021; 13:1285-1292. [PMID: 34754396 PMCID: PMC8554727 DOI: 10.4240/wjgs.v13.i10.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal adenocarcinoma (EAC) derived from long-segment Barrett’s esophagus (LSBE) is extremely rare in Asia. LSBE-related EAC is often difficult to diagnose in the horizontal extent. If the tumor has spread throughout the LSBE, whole circumferential endoscopic submucosal dissection (ESD) should be performed, which is difficult to complete safely. Additionally, whole circumferential ESD can bring refractory postoperative stenosis. We hereby report a case of EAC involving the whole circumference of the LSBE, achieving complete endoscopic removal without complications.
CASE SUMMARY An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy. We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE (C 3.5, M 4.0) using narrow-band imaging magnification endoscopy (NBI-M). We achieved circumferential en bloc resection of the lesion safely with special ESD techniques. Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE, and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin. To prevent post-ESD stenosis, we performed endoscopic local injection of steroids, followed by oral administration of steroids. There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD. In summary, we experienced a rare case of LSBE-related EAC. The horizontal tumor extent was accurately diagnosed by NBI-M. Additionally, we achieve whole circumferential ESD safely without postoperative refractory stenosis.
CONCLUSION NBI-M, ESD, and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.
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Affiliation(s)
- Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Yuichi Majima
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Nishishimbashi 105-8471, Tokyo, Japan
| | - Hidetsugu Yamagishi
- Academic Institutional Research Center, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
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Ishikawa K, Okimoto K, Matsumura T, Hirotsu Y, Amemiya K, Kishimoto T, Akizue N, Ohta Y, Saito K, Maruoka D, Nishimura M, Matsushita K, Mochizuki H, Arai M, Kato J, Yokosuka O, Omata M, Kato N. Comprehensive Analysis of Barrett's Esophagus: Focused on Carcinogenic Potential for Barrett's Cancer in Japanese Patients. Dig Dis Sci 2021; 66:2674-2681. [PMID: 32840705 DOI: 10.1007/s10620-020-06563-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/12/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIM Barrett's esophagus (BE) is a precursor of esophageal adenocarcinoma (EAC). Therefore, an accurate diagnosis of BE is important for the subsequent follow-up and early detection of EAC. However, the definitions of BE have not been standardized worldwide; columnar-lined epithelium (CLE) without intestinal metaplasia (IM) and/or < 1 cm is not diagnosed as BE in most countries. This study aimed to clarify the malignant potential of CLE without IM and/or < 1 cm genetically. METHOD A total of 96 consecutive patients (including nine patients with EAC) who had CLE were examined. Biopsies for CLE were conducted, and patients were divided into those with IM and > 1 cm (Group A) and those without IM and/or < 1 cm (Group B). Malignant potential was assessed using immunochemical staining for p53. Moreover, causative genes were examined using next-generation sequencing (NGS) on ten patients without Helicobacter pylori infection and without atrophic gastritis. RESULT Of the 96 patients, 66 were in Group B. The proportion of carcinoma/dysplasia in Group A was significantly higher than that in Group B (26.7% in Group A and 1.5% in Group B; p < 0.01). However, one EAC patient was found in Group B. In the immunostaining study for non-EAC patients, an abnormal expression of p53 was not observed in Group A, whereas p53 loss was observed in three patients (4.6%) in Group B. In the NGS study, a TP53 mutation was found in Group B. CONCLUSION CLE without IM and/or < 1 cm has malignant potential. This result suggests that patients with CLE as well as BE need follow-up.
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Affiliation(s)
- Kentaro Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan. .,Department of Medical Oncology, Chiba University Hospital, Chiba, Japan.
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kenji Amemiya
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Graduate School of Medicine, Chiba University Hospital, Chiba, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan.,Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Motoi Nishimura
- Division of Laboratory Medicine, Chiba University Hospital, Chiba, Japan
| | | | - Hitoshi Mochizuki
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan.,Department of Medical Oncology, Chiba University Hospital, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
| | - Osamu Yokosuka
- Graduate School of Medicine, University of Chiba, Chiba, Japan
| | - Masao Omata
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan.,Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University Hospital, Inohana 1-8-1, Chiba-City, 260-8670, Japan
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Amano Y, Ishimura N, Ishihara S. Is Malignant Potential of Barrett’s Esophagus Predictable by Endoscopy Findings? Life (Basel) 2020; 10:life10100244. [PMID: 33081277 PMCID: PMC7602941 DOI: 10.3390/life10100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Given that endoscopic findings can be used to predict the potential of neoplastic progression in Barrett’s esophagus (BE) cases, the detection rate of dysplastic Barrett’s lesions may become higher even in laborious endoscopic surveillance because a special attention is consequently paid. However, endoscopic findings for effective detection of the risk of neoplastic progression to esophageal adenocarcinoma (EAC) have not been confirmed, though some typical appearances are suggestive. In the present review, endoscopic findings that can be used predict malignant potential to EAC in BE cases are discussed. Conventional results obtained with white light endoscopy, such as length of BE, presence of esophagitis, ulceration, hiatal hernia, and nodularity, are used as indicators of a higher risk of neoplastic progression. However, there are controversies in some of those findings. Absence of palisade vessels may be also a new candidate predictor, as that reveals degree of intense inflammation and of cyclooxygenase-2 protein expression with accelerated cellular proliferation. Furthermore, an open type of mucosal pattern and enriched stromal blood vessels, which can be observed by image-enhanced endoscopy, including narrow band imaging, have been confirmed as factors useful for prediction of neoplastic progression of BE because they indicate more frequent cyclooxygenase-2 protein expression along with accelerated cellular proliferation. Should the malignant potential of BE be shown predictable by these endoscopic findings, that would simplify methods used for an effective surveillance, because patients requiring careful monitoring would be more easily identified. Development in the near future of a comprehensive scoring system for BE based on clinical factors, biomarkers and endoscopic predictors is required.
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Affiliation(s)
- Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
- Correspondence: ; Tel.: +81-047-711-8700; Fax: +81-047-392-8718
| | - Norihisa Ishimura
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan; (N.I.); (S.I.)
| | - Shunji Ishihara
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan; (N.I.); (S.I.)
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Yamasaki A, Shimizu T, Kawachi H, Yamamoto N, Yoshimizu S, Horiuchi Y, Ishiyama A, Yoshio T, Hirasawa T, Tsuchida T, Sasaki Y, Fujisaki J. Endoscopic features of esophageal adenocarcinoma derived from short-segment versus long-segment Barrett's esophagus. J Gastroenterol Hepatol 2020; 35:211-217. [PMID: 31396997 PMCID: PMC7027738 DOI: 10.1111/jgh.14827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/07/2019] [Accepted: 08/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The study aims to clarify the endoscopic features and clinicopathological differences in superficial Barret's esophageal adenocarcinoma (s-BEA) derived from short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE). METHODS We reviewed data of 130 patients (141 lesions) with pathologically confirmed s-BEA (SSBE: 95 patients and 95 lesions; LSBE: 35 patients and 46 lesions). We analyzed endoscopic and clinicopathological features of s-BEA in patients with SSBE and LSBE. RESULTS The distribution of lesions according to macroscopic findings were as follows (s-BEA in SSBE vs LSBE): flat type (0-IIb), 3.2% (3/95) vs 32.6% (15/46) (P < 0.001); accompanied type 0-IIb, 2.1% (2/95) vs 21.7% (10/46) (P < 0.001); and complex type (0-I + IIb, 0-IIa + IIc, etc.), 30.5% (29/95) vs 50.0% (23/46) (P = 0.025). Complex-type s-BEAs had high incidences of T1b invasions and poorly differentiated components (simple type: 22.5% [20/89] and 18.0% [16/89]; complex type: 59.6% [31/52] and 44.2% [23/52], P < 0.001 and P = 0.002, respectively). In SSBE, 72.6% (69/95) of lesions were located at the right anterior wall (P = 0.01). All flat-type or depressed-type lesions derived from SSBE were identified as reddish areas, whereas only 65.2% (15/23) from LSBE were identified as reddish areas (P < 0.001). CONCLUSIONS In LSBE, flat-type, accompanied-type 0-IIb, and complex-type lesions were significantly more prevalent. Furthermore, complex-type s-BEAs tended to have T1b invasions and poorly differentiated components. S-BEAs in LSBE should be more carefully evaluated on endoscopic appearance including flat-type and complex-type lesions than in SSBE.
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Affiliation(s)
- Akira Yamasaki
- Department of GastroenterologyCancer Institute HospitalTokyoJapan,Department of Gastroenterology and Hepatology, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Tomoki Shimizu
- Department of GastroenterologyYokohama Sakae Kyosai HospitalYokohamaJapan
| | | | | | | | - Yusuke Horiuchi
- Department of GastroenterologyCancer Institute HospitalTokyoJapan
| | | | - Toshiyuki Yoshio
- Department of GastroenterologyCancer Institute HospitalTokyoJapan
| | | | | | - Yutaka Sasaki
- Department of Gastroenterology and Hepatology, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Junko Fujisaki
- Department of GastroenterologyCancer Institute HospitalTokyoJapan
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9
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Amano Y, Nakahara R, Yuki T, Murakami D, Ujihara T, Tomoyuki I, Sagami R, Suehiro S, Katsuyama Y, Hayasaka K, Harada H, Tada Y, Miyaoka Y, Fujishiro H. Relationship between Barrett's esophagus and colonic diseases: a role for colonoscopy in Barrett's surveillance. J Gastroenterol 2019; 54:984-993. [PMID: 31240437 DOI: 10.1007/s00535-019-01600-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Given that risk factors for Barrett's carcinogenesis are predictive, appropriate management and surveillance of Barrett's esophagus (BE) may be provided. The presence of colorectal neoplasms (CRNs) is a possible predictor of the development of BE and the progression to esophageal adenocarcinoma (EAC). We evaluated the relationship between BE or EAC and colonic diseases, including neoplasms and diverticulosis. METHODS Patients (N = 5606) who underwent both colonoscopy and esophagogastroduodenoscopy between January 2016 and December 2017 at three institutions were enrolled. The relationships between the presence of colonic diseases and BE or EAC and other clinical or endoscopic predictors of the presence of BE were investigated retrospectively. RESULTS The prevalence of BE ≥ 1 cm and ≥ 3 cm in length was 13.0% and 0.52%, respectively. BE was closely related with the presence of colorectal adenoma (48.4% vs. 37.2% in non-BE; P < 0.001), adenocarcinoma (16.6% vs. 8.4%, P < 0.001) and colonic diverticulosis (CD) (34.1% vs. 29.3%, P < 0.001). In patients with long-segment BE, CRNs (79.3%, P < 0.001) and CD (48.2%, P = 0.038) were more common. EAC patients also had a statistically significantly higher incidence of CRNs than non-BE patients (87.5% vs. 45.6%, P = 0.027). Diverticulosis at the distal colon correlated significantly with EAC and BE (50.0%, P = 0.010 and 15.4%, P = 0.024, vs. 12.0% in non-BE). Multivariate analysis showed that CRNs (t = 8.55, P < 0.001), reflux esophagitis (t = 5.26, P < 0.001) and hiatal hernia (t = 11.68, P < 0.001) were predictors of BE. CONCLUSIONS The presence of CRNs was strongly associated with BE and EAC. Therefore, colonoscopy may be useful for establishing a strategy for the surveillance of BE.
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Affiliation(s)
- Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, 1271 Wanagaya, Matsudo, 270-2232, Chiba, Japan.
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Takafumi Yuki
- Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Iwaki Tomoyuki
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Ryota Sagami
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Satoshi Suehiro
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Yasushi Katsuyama
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Yasumasa Tada
- Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Youichi Miyaoka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hirofumi Fujishiro
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
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10
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Cook MB, Coburn SB, Lam JR, Taylor PR, Schneider JL, Corley DA. Cancer incidence and mortality risks in a large US Barrett's oesophagus cohort. Gut 2018; 67:418-529. [PMID: 28053055 PMCID: PMC5827961 DOI: 10.1136/gutjnl-2016-312223] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 12/01/2016] [Accepted: 12/04/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Barrett's oesophagus (BE) increases the risk of oesophageal adenocarcinoma by 10-55 times that of the general population, but no community-based cancer-specific incidence and cause-specific mortality risk estimates exist for large cohorts in the USA. DESIGN Within Kaiser Permanente Northern California (KPNC), we identified patients with BE diagnosed during 1995-2012. KPNC cancer registry and mortality files were used to estimate standardised incidence ratios (SIR), standardised mortality ratios (SMR) and excess absolute risks. RESULTS There were 8929 patients with BE providing 50 147 person-years of follow-up. Compared with the greater KPNC population, patients with BE had increased risks of any cancer (SIR=1.40, 95% CI 1.31 to 1.49), which slightly decreased after excluding oesophageal cancer. Oesophageal adenocarcinoma risk was increased 24 times, which translated into an excess absolute risk of 24 cases per 10 000 person-years. Although oesophageal adenocarcinoma risk decreased with time since BE diagnosis, oesophageal cancer mortality did not, indicating that the true risk is stable and persistent with time. Relative risks of cardia and stomach cancers were increased, but excess absolute risks were modest. Risks of colorectal, lung and prostate cancers were unaltered. All-cause mortality was slightly increased after excluding oesophageal cancer (SMR=1.24, 95% CI 1.18 to 1.31), but time-stratified analyses indicated that this was likely attributable to diagnostic bias. Cause-specific SMRs were elevated for ischaemic heart disease (SMR=1.39, 95% CI 1.18 to 1.63), respiratory system diseases (SMR=1.51, 95% CI 1.29 to 1.75) and digestive system diseases (SMR=2.20 95% CI 1.75 to 2.75). CONCLUSIONS Patients with BE had a persistent excess risk of oesophageal adenocarcinoma over time, although their absolute excess risks for this cancer, any cancer and overall mortality were modest.
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Affiliation(s)
- Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Sally B Coburn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Jameson R Lam
- Division of Research, Oakland Medical Center, Kaiser Permanente, Oakland, California, USA
| | - Philip R Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Jennifer L Schneider
- Division of Research, Oakland Medical Center, Kaiser Permanente, Oakland, California, USA
| | - Douglas A Corley
- Division of Research, Oakland Medical Center, Kaiser Permanente, Oakland, California, USA
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Research priority setting in Barrett's oesophagus and gastro-oesophageal reflux disease. Lancet Gastroenterol Hepatol 2017; 2:824-831. [DOI: 10.1016/s2468-1253(17)30250-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023]
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12
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Britton J, Keld R, Prasad N, Hamdy S, McLaughlin J, Ang Y. Effect of diagnosis, surveillance, and treatment of Barrett's oesophagus on health-related quality of life. Lancet Gastroenterol Hepatol 2017; 3:57-65. [PMID: 28970029 DOI: 10.1016/s2468-1253(17)30213-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022]
Abstract
Barrett's oesophagus is a chronic precancerous condition that predisposes patients to the development of oesophageal adenocarcinoma, which, once invasive, carries a poor prognosis. This likelihood of a negative outcome has led to the development of robust surveillance and treatment pathways. The true effect of Barrett's oesophagus on life expectancy and the efficacy of long-term surveillance remains under debate. With these uncertainties and no reliable methods of individual risk stratification, patients must be continually monitored and thus carry the burden of this chronic disease. In this Review, we summarise the major findings concerning the patients' perspective of this disease and its care pathways. Health-related quality of life (HRQoL) measurement has become a valuable metric to assess the effects of disease, the quality of health-care delivery, and treatment efficacy across various disease settings. Research to date has shown significant reductions in HRQoL scores related to Barrett's oesophagus compared with controls from the general population. The scores of patients with Barrett's oesophagus seem to be similar to those of patients with gastro-oesophageal reflux disease. Symptom control appears to be important, but not the only factor, in maximising HRQoL. Most researchers have used generic and disease-specific HRQoL instruments because there are few outcome measures that are validated and reliable in patients with Barrett's oesophagus. These methodologies potentially overlook crucial unmeasured areas that are specific to patients with Barrett's oesophagus. Historically, follow-up care has left some patients with insufficient understanding of the disease, inaccurate perceptions of cancer risk, and an unnecessary psychological burden. A greater understanding of the prevalence of these factors and identification of follow-up needs specific to these patients will help to shape future health-care delivery and improve patient experience.
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Affiliation(s)
- James Britton
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Gastroenterology, Wrightington, Wigan, UK; Leigh NHS Trust, Wigan, UK
| | - Richard Keld
- Department of Gastroenterology, Wrightington, Wigan, UK; Leigh NHS Trust, Wigan, UK
| | - Neeraj Prasad
- Department of Gastroenterology, Wrightington, Wigan, UK; Leigh NHS Trust, Wigan, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Gastroenterology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Gastroenterology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Department of Gastroenterology, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford, UK.
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Erichsen R, Horvath-Puho E, Lund JL, Dellon ES, Shaheen NJ, Pedersen L, Davey Smith G, Sørensen HT. Mortality and cardiovascular diseases risk in patients with Barrett's oesophagus: a population-based nationwide cohort study. Aliment Pharmacol Ther 2017; 45:973-982. [PMID: 28139003 DOI: 10.1111/apt.13962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with Barrett's oesophagus may be at increased risk of mortality overall, and cardiovascular disease has been suggested as the main underlying cause of death. AIM To examine cause-specific mortality and risk of cardiovascular events among patients with Barrett's oesophagus. METHODS Utilising existing Danish data sources (1997-2011), we identified all patients with histologically verified Barrett's oesophagus (n = 13 435) and 123 526 members of the general population matched by age, sex and individual comorbidities. We calculated cause-specific mortality rates and incidence rates of cardiovascular diseases. We then compared rates between patients with Barrett's oesophagus and the general population comparison cohort, using stratified Cox proportional hazard regression. RESULTS Patients with Barrett's oesophagus had a 71% increased risk of overall mortality. The cause-specific mortality rate per 1000 person-years for patients with Barrett's oesophagus was 8.5 for cardiovascular diseases, 14.7 for non-oesophageal cancers, and 5.4 for oesophageal cancer. Compared to the general population cohort, corresponding hazard ratios were 1.26 (95% confidence interval (CI): 1.15-1.38), 1.77 (95% CI: 1.65-1.90), and 19.4 (95% CI: 16.1-23.4), respectively. The incidence rates of cardiovascular diseases per 1000 person-years for Barrett's oesophagus patients and for persons from the general population cohort, respectively, varied from 0.4 and 0.2 for subarachnoid bleeding (hazard ratio 1.10, 95% CI: 0.87-1.39) to 8.1 and 5.9 for congestive heart failure (hazard ratio 1.33, 95% CI: 1.21-1.46). CONCLUSION Prophylactic measures targeted at cardiovascular diseases and non-oesophageal cancers potentially could be more important than measures against oesophageal cancer, for improving prognosis among patients with Barrett's oesophagus.
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Affiliation(s)
- R Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Horvath-Puho
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J L Lund
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - N J Shaheen
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - G Davey Smith
- MRC Integrative Epidemiology Unit (IEU), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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The evolution and outcome of surveillance of Barrett's oesophagus over four decades in a UK District General Hospital. Eur J Gastroenterol Hepatol 2016; 28:1365-1373. [PMID: 27571366 DOI: 10.1097/meg.0000000000000730] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We present the long-term outcome of Barrett's oesophagus (BO) at a District General Hospital set against the increasing numbers of patients with gastro-oesophageal reflux disease (GORD). METHODS Data were collected prospectively over 37 years. Comparison of GORD without Barrett's (NoBO) versus BO was performed from 1/1/1977 to 31/12/2001 when the NoBO database closed and outcomes of all cases of BO diagnosed until 31/12/2011 and followed up until 31/12/2013 have been reported. RESULTS During the period 1977-2001 the number of GORD NoBO cases was 11 610, and that of BO cases was 764 (6.2% of all GORD); total number of BO cases in 1977-2011 was 1468. NoBO patients were younger than BO patients: 52.2 versus 61.6 years. There was a male predominance in both groups: NoBO 55% and BO 62% (P<0.0001). The prevalence of oesophageal adenocarcinoma (OAC) was 87/1468 (5.9%) BO cases. Its incidence was 54/1381 (3.9%); the mean interval between the diagnosis of BO and incident OAC was 9 years (range 13 months-25.4 years); there was one OAC per 192 patient-years of follow-up (0.52% per year). Mortality was significantly lower in 37 patients under endoscopic surveillance at the time OAC was diagnosed (51 vs. 88% P=0.0141) partly because of older age and comorbidity of the other 17, in whom serial endoscopy was contraindicated. A proportional hazards model to allow for age estimated that the hazard rate ratio was lower in the surveillance group; however, this difference did not reach statistical significance (0.64, 95% confidence interval 0.30-1.48, P=0.08). Excluding prevalent cancers from both groups, mortality in BO was double that in NoBO (47 vs. 24%). CONCLUSION These 37 years of observation suggest, but do not confirm, that endoscopic surveillance may reduce the risk of death from OAC. Modern technology is likely to yield better results, but larger prospective studies are needed to confirm the benefits.
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The socioeconomic profile of a Barrett's oesophagus cohort assessed by the 2010 Index of Multiple Deprivation. Eur J Gastroenterol Hepatol 2016; 28:199-204. [PMID: 26571328 DOI: 10.1097/meg.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Several reports have described the relationship between socioeconomic status and oesophageal adenocarcinoma but only one with its precursor condition, Barrett's oesophagus. We therefore investigated such an association. PATIENTS The majority (88%) of patients diagnosed with Barrett's at Rotherham District General Hospital between 28 April 1978 and 31 August 2012 consented to inclusion in the UK Barrett's Oesophagus Registry. Those residing within Rotherham form the basis of this study. METHODS We assessed socioeconomic status using the Index of Multiple Deprivation 2010 scores which can be assigned to every English postcode. The scores for the whole of England were divided into five equal groups; those of the 6257 postcodes within Rotherham (including those of Barrett's patients) were compared against the national quintile relevant to their score. We examined the ratio of observed against expected numbers of Barrett's in each quintile before and since 2001, the median year of diagnosis. RESULTS The study group comprised 1076 patients with Barrett's oesophagus. Before 2001 their distribution across the deprivation quintiles was similar to that expected. Since then it has changed significantly, with 37% more Barrett's patients than expected among the two least deprived quintiles, but 11% fewer than expected in the larger population comprising the two most deprived quintiles (P=0.0001). There was no significant difference in the distribution of sex (P=0.27), nor the mean age at diagnosis between the two time periods (P=0.92). CONCLUSION Since 2001, there has been a major change in the distribution of Barrett's in relation to socioeconomic status, measured by the Index of Multiple Deprivation.
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Pereira AD, Chaves P. Low risk of adenocarcinoma and high-grade dysplasia in patients with non-dysplastic Barrett's esophagus: Results from a cohort from a country with low esophageal adenocarcinoma incidence. United European Gastroenterol J 2015; 4:343-52. [PMID: 27403300 DOI: 10.1177/2050640615612409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/23/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The risk of esophageal adenocarcinoma (EAC) in non-dysplastic Barrett's esophagus (NDBE) is considered to be approximately 0.3% per year or even lower, according to population-based studies. Data from countries with low EAC incidence are scarce. Our principal aim was to determine the incidence of high-grade dysplasia (HGD) and EAC in NDBE. Our secondary aims were to identify the predictors of progression and to calculate the incidence of HGD/EAC, by using the calculation method for surveillance time in population-based studies. MATERIALS AND METHODS A cohort of NDBE patients was prospectively followed up. Cases of HGD and EAC (study end points) diagnosed during the first year of follow-up were considered as prevalent. Only cases with an endoscopic surveillance time > 1 year were included in our analysis. RESULTS We enrolled 331 patients (251 men) in the surveillance program. Their median age was 59 years (interquartile range (IQR): 47-67 years). Their median NDBE length was 3 cm (IQR: 2-4 cm). Of these patients, 80 died during the follow-up (one from EAC) and two were lost to follow-up. After 2284 patient-years of endoscopic follow-up (median surveillance time, 5 years (IQR: 2-10 years)), we found that five cases of HGD and two cases of EAC were diagnosed. The incidence of HGD/EAC was 3.1 cases per 1000 patient-years (95% CI: 1.3-6.0) and that of EAC was 0.9 (95% CI: 0.2-2.9). The incidence of HGD/EAC in short segments (≤ 3 cm) was 0.7 cases per 1000 patient-years (95% CI: 0.3-3.4). The sole variable that we found associated with progression was NDBE length. If the total surveillance time was considered (3537 patient-years), the incidence of HGD and EAC was only slight lower. CONCLUSIONS The incidence of HGD and EAC was very low in NDBE. Therefore, current surveillance guidelines must be reassessed, at least for short-segment BE.
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Affiliation(s)
- António Dias Pereira
- Department of Gastroenterology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal; Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Paula Chaves
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal; Department of Pathology, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal
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Bennett C, Moayyedi P, Corley DA, DeCaestecker J, Falck-Ytter Y, Falk G, Vakil N, Sanders S, Vieth M, Inadomi J, Aldulaimi D, Ho KY, Odze R, Meltzer SJ, Quigley E, Gittens S, Watson P, Zaninotto G, Iyer PG, Alexandre L, Ang Y, Callaghan J, Harrison R, Singh R, Bhandari P, Bisschops R, Geramizadeh B, Kaye P, Krishnadath S, Fennerty MB, Manner H, Nason KS, Pech O, Konda V, Ragunath K, Rahman I, Romero Y, Sampliner R, Siersema PD, Tack J, Tham TCK, Trudgill N, Weinberg DS, Wang J, Wang K, Wong JYY, Attwood S, Malfertheiner P, MacDonald D, Barr H, Ferguson MK, Jankowski J. BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia. Am J Gastroenterol 2015; 110:662-82; quiz 683. [PMID: 25869390 PMCID: PMC4436697 DOI: 10.1038/ajg.2015.55] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/03/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Barrett's esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.
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Affiliation(s)
- Cathy Bennett
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | | | | | | | - Yngve Falck-Ytter
- Case Western Reserve University School of Medicine, Case and VA Medical Center Cleveland, Cleveland, Ohio, USA
| | - Gary Falk
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - John Inadomi
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Khek-Yu Ho
- National University Health System, Singapore, Singapore
| | - Robert Odze
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Eamonn Quigley
- Weill Cornell Medical College and Houston Methodist Hospital, Houston, Texas, USA
| | | | | | | | | | - Leo Alexandre
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yeng Ang
- University of Manchester, Manchester, UK
| | - James Callaghan
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | | | - Rajvinder Singh
- Lyell McEwin Hospital/University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Bita Geramizadeh
- Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Philip Kaye
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sheila Krishnadath
- Gastrointestinal Oncology Research Group, AMC, Amsterdam, The Netherlands
| | | | - Hendrik Manner
- Department of Gastroenterology HSK Wiesbaden, Wiesbaden, Germany
| | - Katie S Nason
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Oliver Pech
- Krankenhaus Barmherzige Brueder, Regensburg, Germany
| | - Vani Konda
- University of Chicago, Chicago, Illinois, USA
| | - Krish Ragunath
- Queens Medical Centre, University of Nottingham, Nottingham, UK
| | | | | | | | | | - Jan Tack
- University of Leuven, Leuven, Belgium
| | | | - Nigel Trudgill
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | | | - Jean Wang
- Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Jennie Y Y Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - David MacDonald
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hugh Barr
- Gloucestershire Royal Hospital, Gloucester, UK
| | | | - Janusz Jankowski
- University Hospitals Coventry and Warwickshire and University of Warwick, Coventry, UK
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Uno G, Ishimura N, Tada Y, Tamagawa Y, Yuki T, Matsushita T, Ishihara S, Amano Y, Maruyama R, Kinoshita Y. Simplified classification of capillary pattern in Barrett esophagus using magnifying endoscopy with narrow band imaging: implications for malignant potential and interobserver agreement. Medicine (Baltimore) 2015; 94:e405. [PMID: 25621687 PMCID: PMC4602634 DOI: 10.1097/md.0000000000000405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The classification of Barrett esophagus (BE) using magnifying endoscopy with narrow band imaging (ME-NBI) is not widely used in clinical settings because of its complexity. To establish a new simplified available classification using ME-NBI.We conducted a cross-sectional study in a single-referral center. One hundred eight consecutive patients with BE using ME-NBI and crystal violet (CV) chromoendoscopy, and histological findings were enrolled. BE areas observed by ME-NBI were classified as type I or II on the basis of capillary pattern (CP), and as closed or open type on the basis of a mucosal pit pattern using CV chromoendoscopy; then, biopsy samples were obtained. We evaluated the relation between CP and pit pattern, expression of the factors with malignant potential, percentage of microvascular density, and interobserver agreement.One hundred thirty lesions from 91 patients were analyzed. Type II CP had more open type pit pattern areas and significantly greater microvascular density than type I. The presence of dysplasia, specialized intestinal metaplasia, expressions of COX-2, CDX2, and CD34, and PCNA index were significantly higher in type II, whereas the multivariate analysis showed that type II was the best predictor for the presence of dysplasia (OR 11.14), CD34 expression (OR 3.60), and PCNA (OR 3.29). Interobserver agreement for this classification was substantial (κ = 0.66).A simplified CP classification based on observation with ME-NBI is presented. Our results indicate that the classification may be useful for surveillance of BE with high malignant potential.
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Affiliation(s)
- Goichi Uno
- From the Department of Gastroenterology and Hepatology (GU, NI, Y. Tada, Y. Tamagawa, SI, YK), Shimane University School of Medicine; Division of Endoscopy (TY), Shimane University Hospital; Department of Pathology (TM, RM), Shimane University School of Medicine, Izumo; Division of Endoscopy (YA), Kaken Hospital, International University of Health and Welfare, Ichikawa, Japan; and Department of Internal Medicine (Y. Tamagawa), University of Texas Southwestern Medical Center, Dallas, TX
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Caygill CP, Gatenby PA, Herceg Z, Lima SC, Pinto LF, Watson A, Wu MS. Comparative genomic analysis of esophageal cancers. Ann N Y Acad Sci 2014; 1325:69-76. [DOI: 10.1111/nyas.12524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Christine P.J. Caygill
- University College London Division of Surgery and Interventional Science; UKBOR; London United Kingdom
| | | | - Zdenko Herceg
- International Agency for Research on Cancer; Epigenetics Group; Lyon France
| | - Sheila C.S. Lima
- Brazilian National Cancer Institute; Program in Molecular Carcinogenesis; Rio de Janeiro Brazil
| | - Luis F.R. Pinto
- Brazilian National Cancer Institute; Program in Molecular Carcinogenesis; Rio de Janeiro Brazil
| | | | - Ming-Shiang Wu
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
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Gatenby P, Caygill C, Wall C, Bhatacharjee S, Ramus J, Watson A, Winslet M. Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus. World J Gastroenterol 2014; 20:9611-9617. [PMID: 25071359 PMCID: PMC4110596 DOI: 10.3748/wjg.v20.i28.9611] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/27/2013] [Accepted: 03/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the lifetime risk of development of esophageal adenocarcinoma and/or high-grade dysplasia in patients diagnosed with Barrett’s esophagus.
METHODS: Data were extracted from the United Kingdom National Barrett’s Oesophagus Registry on date of diagnosis, patient age and gender of 7877 patients from who had been registered from 35 United Kingdom centers. Life expectancy was evaluated from United Kingdom National Statistics data based upon gender and age at year at diagnosis. These data were then used with published estimates of annual adenocarcinoma and high-grade dysplasia incidences from meta-analyses and large population-based studies to estimate overall lifetime risk of development of these study endpoints.
RESULTS: The mean age at diagnosis of Barrett’s esophagus was 61.6 years in males and 67.3 years in females. The mean life expectancy at diagnosis was 23.1 years in males, 20.7 years in females and 22.2 years overall. Using data from published meta-analyses, the lifetime risk of development of adenocarcinoma was between 1 in 8 and 1 in 14 and the lifetime risk of high-grade dysplasia or adenocarcinoma was 1 in 5 to 1 in 6. Using data from 3 large recent population-based cohort studies the lifetime risk of adenocarcinoma was between 1 in 10 and 1 in 37 and of the combined end-point of high-grade dysplasia and adenocarcinoma was between 1 in 8 and 1 in 20. Age at Barrett’s esophagus diagnosis is reducing and life expectancy is increasing, which will partially counter-balance lower annual cancer incidence.
CONCLUSION: There is a significant lifetime risk of development of high-grade dysplasia and adenocarcinoma in Barrett’s esophagus.
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Abstract
The management of Barrett's oesophagus and associated neoplasia has evolved considerably in recent years. Modern endoscopic strategies including endoscopic resection and mucosal ablation can eradicate dysplastic Barrett's and prevent progression to invasive oesophageal cancer. However, several aspects of Barrett's management remain controversial including the stage in the disease process at which to intervene, and the choice of endoscopic or surgical therapy. A review of articles pertaining to the management of Barrett's oesophagus with or without associated neoplasia, was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Embase and Cochrane databases were searched to identify literature relevant to eight pre-defined areas of clinical controversy. The following search terms were used: Barrett's oesophagus; dysplasia; intramucosal carcinoma; endotherapy; endoscopic resection; ablation; oesophagectomy. A significant body of evidence exists to support early endoscopic therapy for high-grade dysplasia (HGD). Although not supported by randomised controlled trial evidence, endoscopic therapy is now favoured ahead of oesophagectomy for most patients with HGD. Focal intramucosal (T1a) carcinomas can be managed effectively using endoscopic and surgical therapy, however surgery should be considered the first line therapy where there is submucosal invasion (T1b). Treatment of low grade dysplasia is not supported at present due to widespread over-reporting of the disease. The role of surveillance endoscopy in non-dysplastic Barrett's remains controversial.
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Solaymani-Dodaran M, Card TR, West J. Cause-specific mortality of people with Barrett's esophagus compared with the general population: a population-based cohort study. Gastroenterology 2013; 144:1375-83, 1383.e1. [PMID: 23583429 DOI: 10.1053/j.gastro.2013.02.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 01/29/2013] [Accepted: 02/05/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Understanding the causes of death in people with Barrett's esophagus (BE) could guide evidence-based practice in the follow-up of these patients. METHODS We identified individuals diagnosed with BE in the UK's Clinical Practice Research Datalink and linked their information with that from England's Hospital Episode Statistics database. Eligible patients (N = 8448) were matched with individuals without BE for age, sex, and general practice (controls, N = 155,212). Causes of death were obtained from the UK's Office for National Statistics. Cox proportional hazard regression, excluding data from the first year of follow-up, was used to estimate hazard ratios and cumulative mortality. Absolute excess risks were calculated by subtracting cause-specific mortality values of controls from those of patients with BE. RESULTS Compared with the control population, patients with BE had increased risks of death from neoplasms and from respiratory and digestive causes but not from circulatory disorders. The annual mortality rate from esophageal cancer among patients with BE was 0.14%; 4.5% of deaths among these patients resulted from this cancer, leading to a cumulative 10-year risk of almost 2%. Nonetheless, the largest single cause of death among patients with BE was ischemic heart disease (5.6 per 1000 patients); 168 patients with BE died of this cause, nearly 4-fold the number that died of esophageal cancer. CONCLUSIONS Among patients with BE, approximately 2% will die of esophageal cancer within 10 years. However, patients with BE died more frequently of other causes, such as ischemic heart disease. Evidence-based strategies are available to prevent this disease and might be more cost-effective for reducing mortality among patients with BE.
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Affiliation(s)
- Masoud Solaymani-Dodaran
- Minimally Invasive Surgery Research Center, Tehran University of Medical Sciences, Rasoul Akram Hospital, Tehran, Iran.
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