Journal ArticleDOI
Barrett's oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel
Lucas C. Duits,K. Nadine Phoa,Wouter L. Curvers,Fiebo J.W. ten Kate,Gerrit A. Meijer,Cees A. Seldenrijk,G. Johan A. Offerhaus,Mike Visser,Sybren L. Meijer,Kausilia K. Krishnadath,Jan G.P. Tijssen,R.C. Mallant-Hent,Jacques J. Bergman +12 more
TLDR
Confirmed LGD in BO has a markedly increased risk of malignant progression, however, the vast majority of patients with community LGD will be downstaged after expert review and have a low progression risk.Abstract:
Objective Reported malignant progression rates for low-grade dysplasia (LGD) in Barrett9s oesophagus (BO) vary widely. Expert histological review of LGD is advised, but limited data are available on its clinical value. This retrospective cohort study aimed to determine the value of an expert pathology panel organised in the Dutch Barrett9s Advisory Committee (BAC) by investigating the incidence rates of high-grade dysplasia (HGD) and oesophageal adenocarcinoma (OAC) after expert histological review of LGD. Design We included all BO cases referred to the BAC for histological review of LGD diagnosed between 2000 and 2011. The diagnosis of the expert panel was related to the histological outcome during endoscopic follow-up. Primary endpoint was development of HGD or OAC. Results 293 LGD patients (76% men; mean 63 years±11.9) were included. Following histological review, 73% was downstaged to non-dysplastic BO (NDBO) or indefinite for dysplasia (IND). In 27% the initial LGD diagnosis was confirmed. Endoscopic follow-up was performed in 264 patients (90%) with a median follow-up of 39 months (IQR 16–72). For confirmed LGD, the risk of HGD/OAC was 9.1% per patient-year. Patients downstaged to NDBO or IND had a malignant progression risk of 0.6% and 0.9% per patient-year, respectively. Conclusions Confirmed LGD in BO has a markedly increased risk of malignant progression. However, the vast majority of patients with community LGD will be downstaged after expert review and have a low progression risk. Therefore, all BO patients with LGD should undergo expert histological review of the diagnosis for adequate risk stratification.read more
Citations
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Journal ArticleDOI
ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus
TL;DR: Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma, and endoscopic surveillance intervals are attenuated, based on recent level 1 evidence.
Journal ArticleDOI
Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement
Bas L. Weusten,Raf Bisschops,Emanuel Coron,Mário Dinis-Ribeiro,Jean-Marc Dumonceau,José Miguel Esteban,Cesare Hassan,Oliver Pech,Alessandro Repici,Jacques J. Bergman,Massimiliano di Pietro +10 more
TL;DR: The Position Statement wishes to contribute to a more cost-effective approach to the care of patients with BE by reducing the number of surveillance endoscopies for patients with a low risk of malignant progression and centralizing care in expert centers for those with high progression rates.
Journal ArticleDOI
Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma
TL;DR: Factors predicting progression from nondysplastic BE to EAC include dysplastic changes on esophageal histology and length of the involved BE segment.
Journal ArticleDOI
BOB CAT: A Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia
Cathy Bennett,Paul Moayyedi,Douglas A. Corley,John deCaestecker,Yngve Falck-Ytter,Gary W. Falk,Nimish Vakil,Scott Sanders,Michael Vieth,John M. Inadomi,David Aldulaimi,Khek Yu Ho,Robert D. Odze,Stephen J. Meltzer,Eamonn Martin Quigley,Stuart Gittens,Peter Watson,Giovanni Zaninotto,Prasad G. Iyer,Leo Alexandre,Yeng Ang,James Callaghan,Rebecca Harrison,Rajvinder Singh,Pradeep Bhandari,Raf Bisschops,Bita Geramizadeh,Philip Kaye,Sheila Krishnadath,M. Brian Fennerty,Hendrik Manner,Katie S. Nason,Oliver Pech,Vani J. Konda,Krish Ragunath,Imdadur Rahman,Yvonne Romero,Richard E. Sampliner,Peter D. Siersema,Jan Tack,Tony C.K. Tham,Nigel Trudgill,David S. Weinberg,Jean Wang,Kenneth K. Wang,Jennie Y. Y Wong,Stephen Attwood,Peter Malfertheiner,David MacDonald,Hugh Barr,Mark K. Ferguson,Janusz Jankowski +51 more
TL;DR: An international, multidisciplinary, systematic search and evidence-based review of Barrett’s esophagus and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD).
Journal ArticleDOI
Diagnosis and Management of Low-Grade Dysplasia in Barrett's Esophagus: Expert Review From the Clinical Practice Updates Committee of the American Gastroenterological Association.
TL;DR: The purpose of this clinical practice update expert review is to define the key principles in the diagnosis and management of low-grade dysplasia (LGD) in Barrett's esophagus patients.
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