Barrett s Esophagus: Old Dog, New Tricks
|
|
- Sophie Richardson
- 5 years ago
- Views:
Transcription
1 Barrett s Esophagus: Old Dog, New Tricks Stuart Jon Spechler, M.D. Chief, Division of Gastroenterology, VA North Texas Healthcare System; Co-Director, Esophageal Diseases Center, Professor of Medicine, Berta M. and Cecil O. Patterson Chair in Gastroenterology, UT Southwestern Medical Center Consultant: Takeda Disclosures Stratified Squamous Epithelium Metaplastic Columnar Epithelium Barrett s Esophagus The condition in which a metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus Affects 5.6% of adult Americans AGA Medical Position Statement. Gastroenterology 2011;140:1084. Barrett s Metaplasia Esophageal Adenocarcinoma 1
2 Metaplasia One type of adult tissue replaces another Response to chronic tissue injury Esophageal mucosal damage can heal through: Regeneration of squamous epithelium Columnar metaplasia GERD Reflux Esophagitis Mucosal Damage Stratified Squamous Epithelium (Normal Esophagus) Intestinal Metaplasia (Barrett s Esophagus) Pathogenesis of Barrett s Metaplasia Potential Progenitor Cells for Columnar Metaplasia Mature squamous cells change into columnar cells Transdifferentiation involves individual differentiated cells Immature progenitor cells Can produce and maintain multiple different cell types - Progenitor cells native to esophagus - Basal cells of squamous epithelium - Cells in submucosal gland ducts - Progenitor cells in proximal stomach - Gastric cardia - Embryonic-type cells at GEJ - Progenitor cells from bone marrow Must involve reflux-related reprogramming of the expression of developmental transcription factors Squamous Epithelium Goblet Cells Intestinal Metaplasia 2
3 Barrett s Esophagus Goblet Cells Intestinal Metaplasia No Goblet Cells Cardiac Mucosa British Society of Gastroenterology Definition of Barrett s Esophagus 2014 An esophagus in which any portion of the normal distal squamous epithelial lining has been replaced by metaplastic columnar epithelium, which is clearly visible endoscopically ( 1 cm) above the GOJ and confirmed histopathologically from oesophageal biopsies. Includes cardiac mucosa Fitzgerald RC et al. Gut 2014;63:7-42. Can be metaplastic, acquired as a result of reflux Expresses molecular markers of intestinal differentiation (e.g. villin, CDX2) Exhibits DNA content abnormalities similar to intestinal metaplasia Frequently found next to esophageal adenocarcinomas One study suggests cancer risk is similar to that for intestinal metaplasia Kelty CJ. Scand J Gastroenterol 2007;42:1271. Cardiac Mucosa 3
4 Estimates of cancer risk in Barrett s based on studies that included patients with intestinal metaplasia either primarily or exclusively Goblet cell unlikely to be cell of origin for adenocarcinoma, but goblet cell a good marker for malignant predisposition Intestinal Metaplasia (with goblet cells) Most studies suggest cancer risk for cardiac mucosa alone is minimal Westerhoff M. Clin Gastroenterol Hepatol 2012;10:1232. Disagreement on Histological Criteria for Barrett s Esophagus Should Barrett s esophagus be defined as... a histological curiosity? (a mucosal metaplasia irrespective of its clinical importance) a medical condition? (a mucosal metaplasia that predisposes to cancer) Barrett s Esophagus Conceptual Definition The condition in which any extent of metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus Diagnostic Criterion Intestinal metaplasia (with goblet cells) in the esophagus AGA Medical Position Statement. Gastroenterology 2011;140:1084. Risk Factors for Barrett s Esophagus and Esophageal Adenocarcinoma Chronic GERD Heartburn, hiatal hernia Age >50 years Uncommon in children Male sex White race Less common in African-Americans, Uncommon in Asians Obesity Intra-abdominal fat distribution 4
5 AGA Medical Position Statement on Endoscopic Screening for Barrett s Esophagus We recommend against screening the general population with GERD for Barrett s esophagus. In patients with multiple risk factors associated with esophageal adenocarcinoma, we suggest screening for Barrett s esophagus. Norman Barrett Chronic GERD, hiatal hernia, age 50, male gender, white race, elevated BMI, intra-abdominal body fat distribution Spechler et al. Gastroenterology 2011;140:1084. U.S. Incidence of Esophageal Adenocarcinoma Has Been Rising Incidence per 1,000, Incidence Time Trend 25.6 per million per million Pohl H. Cancer Epidemiol Biomarkers Prev 2010;19:1468. Estimates of Cancer Risk for Individual Patients with Non-Dysplastic Barrett s Have Been Falling 1990s Estimate: 1% per year 1 in 100 patients per year Drewitz. Am J Gastroenterol 1997;92: s Estimate: 0.5% per year 1 in 200 patients per year Shaheen. Gastroenterology 2000;119: Estimate: 0.25% per year 1 in 400 patients per year Endoscopic Surveillance Might Not Decrease Mortality from Esophageal Adenocarcinoma 8,272 pts. with Barrett s esophagus (BE) Surveillance 351 pts. endoscopy with esophageal within 3 adenocarcinoma years was NOT (EAC) associated with decreased risk of death from esophageal cancer 70 EAC in pts. with prior diagnosis of BE ( 6 months) (adjusted odds ratio 0.99; 95% CI ) Cases 38 pts. with confirmed death from esophageal cancer 55% surveillance endoscopy performed within 3 years Controls 101 living Barrett s pts. matched for age, sex, follow-up duration 60% surveillance endoscopy performed within 3 years Corley DA. Gastroenterology 2013;145:312. 5
6 Do Proton Pump Inhibitors (PPIs) Prevent Cancer in Barrett s Esophagus? PPIs are the most effective medical treatment for reflux esophagitis Decrease gastric acid production Decrease acid reflux Heal reflux esophagitis Evidence that PPIs prevent carcinogenesis in Barrett s esophagus is indirect and not proven in controlled trials. PPIs Reduce the Risk of Neoplastic Progression in Barrett s Esophagus 540 Barrett s patients, median follow-up 5.2 years PPI Nonusers PPI use associated with 75% reduction in risk of neoplastic progression PPI Users Kastelein F. Clin Gastroenterol Hepatol 2013;11: Norman Barrett Age 13 AGA Medical Position Statement on the Treatment of GERD in Barrett s Esophagus GERD therapy with medication effective to treat GERD symptoms and to heal reflux esophagitis is clearly indicated. Antireflux surgery is not more effective than medical therapy for prevention of cancer in Barrett s esophagus. We recommend against attempts to eliminate esophageal acid exposure (PPIs in doses >once daily or antireflux surgery) for cancer prevention. Spechler et al. Gastroenterology 2011;140:1084. AGA Medical Position Statement on Endoscopic Surveillance for Barrett s Esophagus We suggest that endoscopic surveillance [with biopsy] be performed in patients with Barrett s esophagus. Norman Barrett We suggest the following surveillance intervals: No dysplasia: 3-5 years Low-grade dysplasia: 6-12 months High-grade dysplasia in the absence of eradication therapy: 3 months Spechler et al. Gastroenterology 2011;140:
7 The Cancer Risk for High-Grade Dysplasia in Barrett s is Sufficient to Warrant Intervention AGA Medical Position Statement on the Management of Barrett s Esophagus High Grade Dysplasia ~6% per year Cancer Rastogi. Gastrointest Endosc 2008;67:394. Spechler. Am J Gastroenterol 2005;100:927. AGA Medical Position Statement. Gastroenterology 2011;140:1084. Norman Barrett We recommend endoscopic eradication therapy rather than surveillance for treatment of patients with confirmed highgrade dysplasia in Barrett s esophagus. Spechler et al. Gastroenterology 2011;140:1084. Muscularis mucosae HGD T1 T2 Epithelium Lamina propria Basement membrane T1 T Staging of Esophageal Cancer T2 T3 T4 Muscularis mucosae None considered curable by endoscopic therapy. Drawing courtesy of Tom Rice Drawing courtesy of Tom Rice 7
8 HGD T1 T2 High Grade Dysplasia Intramucosal Carcinoma Muscularis mucosae T1a T1b T1b: LN mets >10% Potentially curable with endoscopic therapy Potentially metastatic Endoscopic therapy is appropriate for neoplasms confined to the mucosa. Drawing courtesy of Tom Rice Systematic Review: Risk of Lymph Node Metastases for High Grade Dysplasia (HGD) or Intramucosal Carcinoma (IMC) in Barrett s Esophagus Reviewed studies that included: - Patients who had esophagectomy for HGD or IMC and - Final surgical pathology results (lymph node status) Identified 70 relevant articles 1,874 patients who had esophagectomy for HGD (524 patients) or IMC (1,350 patients) Lymph node metastases in 26 of 1,874 patients (1.39%, 95% CI 0.86% %) Dunbar K, Spechler S. Am J Gastroenterol 2012;107:850. Accurate T Staging Crucial to Determine if Curative Endoscopic Therapy Feasible High Grade Dysplasia, Intramucosal Carcinoma Lymph node metastases in 1%-2% Curative endoscopic therapy feasible Submucosal invasion Lymph node metastases in >10% Failure rate for endoscopic therapy unacceptable Endoscopic mucosal resection (EMR) the best procedure for T staging EMR is as much a staging procedure as it is a therapeutic procedure. If EMR shows submucosal invasion, then endoscopic therapy is not advised. 8
9 Radiofrequency Ablation (RFA) Radiofrequency Energy Generator Radiofrequency Ablation of Barrett s Esophagus Closely spaced electrodes Ablated Barrett s Metaplasia Randomized, Sham-Controlled Trial of Radiofrequency Ablation for Dysplasia in Barrett s Shaheen N et al. N Engl J Med 2009;360: Radiofrequency Ablation of Dysplasia Prevents Neoplastic Progression at One Year % with Progression 3.6% 16.3% Progression of Neoplasia Radiofrequency ablation Sham ablation 9.3% 1.2% Progression to Cancer Shaheen. N Engl J Med 2009;360:
10 Complications of Radiofrequency Ablation in 84 Patients 5 esophageal strictures (6%) 1 UGI Bleed (1%) 2 hospitalizations for chest pain (2%) Shaheen. N Engl J Med 2009;360: Randomized Trial of RFA vs. Surveillance for Low- Grade Dysplasia (LGD) in Barrett s Esophagus 136 patients with LGD confirmed by expert pathologist Randomized to RFA (68 pts.) or surveillance (68 pts.) Progression to high-grade dysplasia or cancer at 3 years Data 1.5% & RFA Safety group Monitoring Board early termination: RFA 26.5% superior surveillance to surveillance group for preventing neoplastic progression 25% Potential risk of for progression patient safety issues (95% CI if trial %, continued P<.001) Progression to cancer at 3 years 1.5% RFA group 8.8% surveillance group 7.4% risk of cancer (95% CI %, P=.03) Phoa KN. JAMA 2014;311:1209. Randomized Trial of RFA vs. Surveillance for Low- Grade Dysplasia (LGD) in Barrett s Esophagus Issues Median 3 RFA sessions per patient 12% of RFA-treated patients developed strictures 28% of patients in surveillance group had no dysplasia detectable on follow-up No patient in surveillance group developed an unresectable tumor No patient in surveillance died of cancer Endoscopic Eradication Therapy for Mucosal Neoplasia in Barrett s Esophagus 2015 EMR of mucosal irregularities for staging and therapy Radiofrequency ablation of remaining Barrett s metaplasia to minimize metachronous neoplasia Phoa KN. JAMA 2014;311:
11 Recurrent HGD/IMC Recurrence of Neoplasia and Metaplasia after Endoscopic Eradication of Mucosal Neoplasia 246 patients with HGD or IMC in Barrett s esophagus Completely eradicated intestinal metaplasia (IM) in 80% Recurrence of Neoplasia after Complete Eradication of IM 25% HGD IMC Follow-Up Months Recurrent IM Recurrence of Metaplasia after Complete Eradication of IM 50% HGD IMC Follow-Up Months Small AJ et al. Gastrointest Endosc 2015;81: RFA for Non-Dysplastic Barrett s Esophagus? Generally requires several endoscopies for complete eradication Complication rate low, but not trivial Substantial rate of recurrence of metaplasia Efficacy in preventing cancer not established Does not eliminate need for surveillance Chronic GERD symptoms and 1 risk factor(s) for adenocarcinoma (Age>50, male, white, hiatal hernia, obesity, intra-abdominal body fat, smoking) No Barrett s No more screening on screening Consider screening endoscopy Barrett s esophagus No dysplasia Low-grade dysplasia High-grade dysplasia or intramucosal Ca Surveillance endoscopy every 3-5 yrs Spechler S, Souza R. N Engl J Med 2014;371:836. Have diagnosis confirmed by expert pathologist Low-grade dysplasia Surveillance endoscopy every 6-12 months or endoscopic eradication High-grade dysplasia or intramucosal Ca Endoscopic eradication AGA Medical Position Statement on the Management of Barrett s Esophagus Endoscopic eradication therapy is not suggested for the general population of patients with Barrett s esophagus in the absence of dysplasia. Norman Barrett RFA should be a therapeutic option for select individuals with non-dysplastic Barrett s esophagus who are judged to be at increased risk for progression to HGD or cancer. Specific criteria that identify this population have not been fully defined. Spechler et al. Gastroenterology 2011;140:
12 Knowledge is knowing a tomato is a fruit. Wisdom is knowing not to put it in a fruit salad. 12
Barrett s Esophagus. Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI
Barrett s Esophagus Abdul Sami Khan, M.D. Gastroenterologist Aurora Healthcare Burlington, Elkhorn, Lake Geneva, WI A 58 year-old, obese white man has had heartburn for more than 20 years. He read a magazine
More informationBarrett s Esophagus: Are We Making any Progress?
3/22/217 arrett s Esophagus: re We Making any Progress? Stuart Jon Spechler, M.D. hief, Division of Gastroenterology, V North Texas Healthcare System; o-director, Esophageal Diseases enter, Professor of
More informationHistory. Prevalence at Endoscopy. Prevalence and Reflux Sx. Prevalence at Endoscopy. Barrett s Esophagus: Controversy and Management
Barrett s Esophagus: Controversy and Management History Norman Barrett (1950) Chronic Peptic Ulcer of the Oesophagus and Oesophagitis Allison and Johnstone (1953) The Oesophagus Lined with Gastric Mucous
More informationAGA SECTION. Gastroenterology 2016;150:
Gastroenterology 2016;150:1026 1030 April 2016 AGA Section 1027 Procedural intervention (3) Upper endoscopy indications 3 6 Non-response of symptoms to a 4 8 week empiric trial of twice-daily PPI Troublesome
More informationDefinition of GERD American College of Gastroenterology
Definition of GERD American College of Gastroenterology GERD is defined as chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus DeVault et al. Am J
More informationBarrett s esophagus. Barrett s neoplasia treatment trends
Options for endoscopic treatment of Barrett s esophagus Patrick S. Yachimski, MD MPH Director of Pancreatobiliary Endoscopy Assistant Professor of Medicine Division of Gastroenterology, Hepatology & Nutrition
More informationJoel A. Ricci, MD SUNY Downstate Medical Center Department of Surgery
Joel A. Ricci, MD SUNY Downstate Medical Center Department of Surgery Norman Barrett (1950) described the esophagus as: that part of the foregut, distal to the cricopharyngeal sphincter, which is lined
More informationPresent Day Management of Barrett s Esophagus
Slide 1 Present Day Management of Barrett s Esophagus Kinnari R. Kher, M.D. Slide 2 Goals Risk factors for development of Barrett s esophagus Risks for progression to Esophageal Adenocarcinoma Current
More informationManagement of Barrett s Esophagus. Case Presentation
Management of Barrett s Esophagus Lauren B. Gerson MD, MSc Associate Clinical Professor, UCSF Director of Clinical Research Gastroenterology Fellowship Program California Pacific Medical Center San Francisco,
More informationAblation for Barrett s Esophagus: Burn or Freeze
Ablation for Barrett s Esophagus: Burn or Freeze John R. Saltzman MD Director of Endoscopy Brigham and Women s Hospital Professor of Medicine Harvard Medical School Disclosures No relevant disclosures
More informationNew Developments in the Endoscopic Diagnosis and Management of Barrett s Esophagus
New Developments in the Endoscopic Diagnosis and Management of Barrett s Esophagus Prateek Sharma, MD Key Clinical Management Points: Endoscopic recognition of a columnar lined distal esophagus is crucial
More informationBarrett s Esophagus: Ablate Everyone?
Nicholas J. Shaheen, MD, MPH, FACG Barrett s Esophagus: Ablate Everyone? Nicholas J. Shaheen, MD, MPH, FACG Center for Esophageal Diseases and Swallowing University of North Carolina Greetings from UNC,
More informationMANAGEMENT OF BARRETT S RELATED NEOPLASIA IN 2018
MANAGEMENT OF BARRETT S RELATED NEOPLASIA IN 2018 Sachin Wani Medical Director Esophageal and Gastric Center Division of Gastroenterology and Hepatology University of Colorado Anschutz Medical Campus DISCLOSURES
More informationGregory G. Ginsberg, M.D.
Radiofrequency Ablation for Barrett s Esophagus with HGD Gregory G. Ginsberg, M.D. Professor of Medicine University of Pennsylvania School of Medicine Abramson Cancer Center Gastroenterology Division Executive
More informationHistopathology of Endoscopic Resection Specimens from Barrett's Esophagus
Histopathology of Endoscopic Resection Specimens from Barrett's Esophagus Br J Surg 38 oct. 1950 Definition of Barrett's esophagus A change in the esophageal epithelium of any length that can be recognized
More informationEndoscopic Management of Barrett s Esophagus
Endoscopic Management of Barrett s Esophagus Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center Barrett s Esophagus Consequence of chronic GERD Mean
More informationACG Clinical Guideline: Diagnosis and Management of Barrett s Esophagus
ACG Clinical Guideline: Diagnosis and Management of Barrett s Esophagus Nicholas J. Shaheen, MD, MPH, FACG 1, Gary W. Falk, MD, MS, FACG 2, Prasad G. Iyer, MD, MSc, FACG 3 and Lauren Gerson, MD, MSc, FACG
More informationBarrett s Esophagus: What to Do for No Dysplasia, LGD, and HGD?
Barrett s Esophagus: What to Do for No Dysplasia, LGD, and HGD? Nicholas Shaheen, MD, MPH Center for Esophageal Diseases and Swallowing University of North Carolina 1 Outline What are the risks of progression
More informationThis medical position statement considers a series of
GASTROENTEROLOGY 2011;140:1084 1091 American Gastroenterological Association Medical Position Statement on the Management of Barrett s Esophagus The Institute Medical Position Panel consisted of the authors
More informationIs Radiofrequency Ablation Effective In Treating Barrett s Esophagus Patients with High-Grade Dysplasia?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 12-2016 Is Radiofrequency Ablation Effective
More informationLearning Objectives:
Crescent City GI Update 2018 Ochsner Clinic, NOLA Optimizing Endoscopic Evaluation of Barrett s Esophagus What Should I Do in My Practice? Gregory G. Ginsberg, M.D. Professor of Medicine University of
More informationEverything Esophagus: Barrett s Esophagus. Nicholas Shaheen, MD, MPH Center for Esophageal Diseases and Swallowing University of North Carolina
Everything Esophagus: Barrett s Esophagus Nicholas Shaheen, MD, MPH Center for Esophageal Diseases and Swallowing University of North Carolina The Most Important Thing Stayed the Same Adenocarcinoma A
More informationCurrent Management: Role of Radiofrequency Ablation
Esophageal Adenocarcinoma And Barrett s Esophagus: Current Management: Role of Radiofrequency Ablation Ketan Kulkarni, MD Regional Gastroenterology Associates of Lancaster INTRODUCTION The prognosis of
More informationManagement of Barrett s: From Imaging to Resection
Management of Barrett s: From Imaging to Resection Michael Wallace, MD, MPH, FACG Professor of Medicine Mayo Clinic Florida Goals of Endoscopic Evaluation in Barrett s Detect Barrett s and dysplasia Reduce/eliminate
More informationChanges to the diagnosis and management of Barrett s Oesophagus
Changes to the diagnosis and management of Barrett s Oesophagus A review of the new BSG and NICE guidelines and best practice Anjan Dhar DM, MD, FRCPE, AGAF, MBBS (Hons.), Cert. Med. Ed Senior Lecturer
More informationCitation for published version (APA): Phoa, K. Y. N. (2014). Endoscopic management of Barrett s esophagus with dysplasia
UvA-DARE (Digital Academic Repository) Endoscopic management of Barrett s esophagus with dysplasia Phoa, Nadine Link to publication Citation for published version (APA): Phoa, K. Y. N. (2014). Endoscopic
More informationWhat s New in the Management of Esophageal Disease
What s New in the Management of Esophageal Disease Philip O. Katz, MD Chairman, Division of Gastroenterology Einstein Medical Center Philadelphia Clinical Professor of Medicine Jefferson Medical College
More informationSpeaker disclosure. Objectives. GERD: Who and When to Treat 7/21/2015
GERD: Who and When to Treat Eugenio J Hernandez, MD Gastrohealth, PL Assistant Professor of Clinical Medicine, FIU Herbert Wertheim School of Medicine Speaker disclosure I do not have any relevant commercial
More informationAmerican Journal of Gastroenterology. Volumetric Laser Endomicroscopy Detects Subsquamous Barrett s Adenocarcinoma
Volumetric Laser Endomicroscopy Detects Subsquamous Barrett s Adenocarcinoma Journal: Manuscript ID: AJG-13-1412.R1 Manuscript Type: Letter to the Editor Keywords: Barrett-s esophagus, Esophagus, Endoscopy
More informationRFA and Cyrotherapy for Esophageal Disease
RFA and Cyrotherapy for Esophageal Disease Daniel L. Miller MD Chief, General Thoracic Surgery WellStar Healthcare System/ Mayo Clinic Care Network Clinical Professor of Surgery Medical College of Georgia/
More informationBarrett s Esophagus: State of the Art Management
In the Name of God Barrett s Esophagus: State of the Art Management Siavosh Nasseri-Moghaddam MD, MPH, AGAF Associate Professor of Medicine Digestive Disease Research Center, Shariati Hospital, TUMS IAGH
More informationOesophagus and Stomach update dysplasia and early cancer
Oesophagus and Stomach update dysplasia and early cancer Dr Tim Bracey STR teaching 13/4/16 Please check pathkids.com for previous talks One of the biggest units in the country (100 major resections per
More informationMedicare Advantage Medical Policy
Medicare Advantage Medical Policy Current Policy Effective Date: 1/1/18 Title: Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus Description/Background Barrett Esophagus and the
More informationBarrett esophagus. Bible class Inselspital
Barrett esophagus Bible class Inselspital 2015.08.10 Guidelines Definition? BSG: ACG: Definition? BSG: ACG: What are the arguments for and against IM as prerequisite for the Dg? What are the arguments
More informationBarrett s Esophagus: Review of Diagnostic Issues and Pre- Neoplastic Lesions
Barrett s Esophagus: Review of Diagnostic Issues and Pre- Neoplastic Lesions Robert Odze, MD, FRCPC Chief, Gastrointestinal Pathology Associate Professor of Pathology Brigham and Women s Hospital Harvard
More informationThe Pathologist s Role in the Diagnosis and Management of Neoplasia in Barrett s Oesophagus Cian Muldoon, St. James s Hospital, Dublin
The Pathologist s Role in the Diagnosis and Management of Neoplasia in Barrett s Oesophagus Cian Muldoon, St. James s Hospital, Dublin 24.06.15 Norman Barrett Smiles [A brief digression - Chair becoming
More informationCurrent Management of Low-Grade Dysplasia in Barrett Esophagus
Current Management of Low-Grade Dysplasia in Barrett Esophagus Gary W. Falk, MD, MS Dr Falk is a professor of medicine in the Division of Gastroenterology at the University of Pennsylvania Perelman School
More informationIn 1998, the American College of Gastroenterology issued ALIMENTARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2012;10:1232 1236 ALIMENTARY TRACT Effects of Dropping the Requirement for Goblet Cells From the Diagnosis of Barrett s Esophagus MARIA WESTERHOFF,* LINDSEY HOVAN,
More informationEndoscopic Radiofrequency Ablation or Cryoablation for Barrett s Esophagus
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett s Esophagus Policy Number: 2.01.80 Last Review: 6/2018 Origination: 6/2012 Next Review: 6/2019 Policy Blue Cross and Blue Shield of Kansas
More informationHiatal Hernias and Barrett s esophagus. Dr Sajida Ahad Mercy General Surgery
Hiatal Hernias and Barrett s esophagus Dr Sajida Ahad Mercy General Surgery Objectives Identify the use of different diagnostic modalities for hiatal hernias List the different types of hiatal hernias
More informationBurning Issues in the Esophagus
Burning Issues in the Esophagus Elizabeth Montgomery, MD Johns Hopkins Medical Institutions Dr. Montgomery reports no relevant financial relationships with commercial interests. Squamous Epithelium Muscularis
More informationFaculty Disclosure. Objectives. State of the Art #3: Referrals for Gastroscopy (focus on common esophagus problems) 24/11/2014
State of the Art #3: Referrals for Gastroscopy (focus on common esophagus problems) Dr. Amy Morse November 2014 Faculty: Amy Morse Faculty Disclosure Relationships with commercial interests: Grants/Research
More informationSixteen-year follow-up of Barrett s esophagus, endoscopically treated with argon plasma coagulation
Original Article Sixteen-year of Barrett s esophagus, endoscopically treated with argon plasma coagulation United European Gastroenterology Journal 2014, Vol. 2(5) 367 373! Author(s) 2014 Reprints and
More informationQuality ID #249 (NQF 1854): Barrett s Esophagus National Quality Strategy Domain: Effective Clinical Care
Quality ID #249 (NQF 1854): Barrett s Esophagus National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process DESCRIPTION: Percentage
More informationEndoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus Policy Number: Original Effective Date: MM.02.005 09/01/2010 Line(s) of Business: Current Effective Date: PPO; HMO; QUEST Integration
More informationCryospray ablation using pressurized CO 2 for ablation of Barrett s esophagus with early neoplasia: early termination of a prospective series
E17 Cryospray ablation using pressurized CO 2 for ablation of Barrett s esophagus with early neoplasia: early termination of a prospective series Authors Romy E. Verbeek 1, Frank P. Vleggaar 1, Fiebo J.
More informationDisclosures. Gastroesophageal Reflux Disease. Gastroesophageal Reflux Disease
Kunal Jajoo, MD Brigham and Women s Hospital July 2012 Disclosures Spouse is a physician employed by Boston Scientific Corporation The content of this lecture equitably discusses products of multiple companies
More informationQuality ID #249 (NQF 1854): Barrett s Esophagus National Quality Strategy Domain: Effective Clinical Care
Quality ID #249 (NQF 1854): Barrett s Esophagus National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS ONLY MEASURE TYPE: Process DESCRIPTION: Percentage
More informationQuiz Adenocarcinoma of the distal stomach has been increasing in the last 20 years. a. True b. False
Quiz 1 1. Which of the following are risk factors for esophagus cancer. a. Obesity b. Gastroesophageal reflux c. Smoking and Alcohol d. All of the above 2. Adenocarcinoma of the distal stomach has been
More informationHow to remove BE cancer: EMR or ESD? Expected outcome
How to remove BE cancer: EMR or ESD? Expected outcome Presented by Horst Neuhaus Institution Dpt. of Gastroenterology Evangelisches Krankenhaus Düsseldorf, Germany Indications for endoscopic resection
More informationFrom reflux to esophageal cancer. Josh Boys, MD TCV 2 nd year indentured servant
From reflux to esophageal cancer Josh Boys, MD TCV 2 nd year indentured servant The Pathway Esophageal Squamous epithelium+reflux Columnar lined esophagus (CLE) or Cardiac mucosa Intestinal Metaplasia
More informationBarrett's Esophagus: Sorting Out the Controversy
Barrett's Esophagus: Sorting Out the Controversy Learning Objectives 1. Identify the challenges in screening for Barrett s esophagus 2. Demonstrate comprehension of the risk of progression of Barrett s
More informationIs intestinal metaplasia a necessary precursor lesion for adenocarcinomas of the distal esophagus, gastroesophageal junction and gastric cardia?
Diseases of the Esophagus (2007) 20, 36 41 DOI: 10.1111/j.1442-2050.2007.00638.x Blackwell Publishing Asia Original article Is intestinal metaplasia a necessary precursor lesion for adenocarcinomas of
More informationSAM PROVIDER TOOLKIT
THE AMERICAN BOARD OF PATHOLOGY Maintenance of Certification (MOC) Program SAM PROVIDER TOOLKIT Developing Self-Assessment Modules (SAMs) www.abpath.org The American Board of Pathology (ABP) approves educational
More informationESOPHAGEAL CANCER AND GERD. Prof Salman Guraya FRCS, Masters MedEd
ESOPHAGEAL CANCER AND GERD Prof Salman Guraya FRCS, Masters MedEd Learning objectives Esophagus anatomy and physiology Esophageal cancer Causes, presentations of esophageal cancer Diagnosis and management
More informationEndoscopic Submucosal Dissection ESD
Endoscopic Submucosal Dissection ESD Peter Draganov MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition University of Florida Gastrointestinal Cancer Lesion that Can be Treated
More informationBarrett s Esophagus: State of the Art. Food Getting Stuck
Barrett s Esophagus: State of the Art Nicholas J. Shaheen, MD, MPH Center for Esophageal Diseases and Swallowing University of North Carolina SOM Food Getting Stuck 73-year-old retired Wilmington police
More informationChapter 2 Complications of Gastroesophageal Reflux Disease
Chapter 2 Complications of Gastroesophageal Reflux Disease Patrick Yachimski Acute esophageal exposure to gastric and/or duodenal refluxate can result in pyrosis and symptomatic gastroesophageal reflux
More informationGreater Manchester & Cheshire Guidelines for Pathology Reporting of Oesophageal and Gastric Malignancy
Greater Manchester & Cheshire Guidelines for Pathology Reporting of Oesophageal and Gastric Malignancy Authors: Dr Stephen Hayes, Dr David Bisset, Dr Gordon Armstrong, Dr Sue Pritchard 1. General Comments
More informationWhat Is Barrett s Esophagus?
What Is Barrett s Esophagus? Having Barrett s esophagus means the cells lining the esophagus (the tube that links the mouth and the stomach) have changed into types of intestinal cells that are not normal
More informationBarrett s Esophagus. Radiofrequency Ablation with the HALO Technology A Reference Book
Radiofrequency Ablation with the HALO Technology A Reference Book 540 Oakmead Parkway, Sunnyvale, CA 94085 What is Barrett s esophagus? Barrett s esophagus is a change that occurs within the cellular lining
More informationEditorial: Advanced endoscopic therapeutics in Barrett s neoplasia; where are we now and where are we heading?
Editorial: Advanced endoscopic therapeutics in Barrett s neoplasia; where are we now and where are we heading? Dr. Gaius Longcroft-Wheaton MB,BS, MD, MRCP(UK), MRCP(Gastro) Consultant gastroenterologist
More informationGland ducts and multilayered epithelium in mucosal biopsies from gastroesophageal-junction region are useful in characterizing esophageal location
Diseases of the Esophagus (2005) 18, 87 92 2005 ISDE Blackwell Publishing, Ltd. Original article Gland ducts and multilayered epithelium in mucosal biopsies from gastroesophageal-junction region are useful
More informationVolumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett s esophagus
E318 Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment esophagus Authors Institution Arvind J. Trindade, Benley J. George, Joshua Berkowitz,
More informationSection: Medicine Effective Date: July 15, 2015 Subsection: Original Policy Date: December 7, 2011 Subject:
Last Review Status/Date: June 2015 Page: 1 of 16 Cryoablation for Barrett s Esophagus Description Barrett s esophagus (BE) is a condition in which the normal squamous epithelium is replaced by specialized
More informationRelative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia
Gut 2000;46:9 13 9 PAPERS Division of Gastroenterology, University of Kansas, VA Medical Center, Kansas City, Missouri, USA P Sharma A P Weston Department of Pathology, VA Medical Center, Kansas M Topalovski
More informationAccepted Manuscript. CGH Editorial: Sound the Alarm for Barrett s Screening! Tarek Sawas, M.D., M.P.H., David A. Katzka, M.D
Accepted Manuscript CGH Editorial: Sound the Alarm for Barrett s Screening! Tarek Sawas, M.D., M.P.H., David A. Katzka, M.D PII: S1542-3565(18)31093-0 DOI: 10.1016/j.cgh.2018.10.010 Reference: YJCGH 56132
More informationEndoscopic Radiofrequency Ablation or Cryoablation for Barrett`s Esophagus. Original Policy Date
MP 2.01.52 Endoscopic Radiofrequency Ablation or Cryoablation for Barrett`s Esophagus Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature
More informationBarrett s Oesophagus Information Leaflet THE DIGESTIVE SYSTEM. gutscharity.org.
THE DIGESTIVE SYSTEM http://healthfavo.com/digestive-system-for-kids.html This factsheet is about Barrett s Oesophagus Barrett s Oesophagus is the term used for a pre-cancerous condition where the normal
More informationHenry Moon was one of the giants in academic pathology during my early years.
Henry Moon was one of the giants in academic pathology during my early years. Controversial stuff that occurs slightly above, within or slightly below the gastroesophageal junction, including Barrett s
More informationACG Clinical Guideline: Diagnosis and Management of Barrett s Esophagus
30 PRACTICE GUIDELINES nature publishing group CME ACG Clinical Guideline: Diagnosis and Management of Barrett s Esophagus Nicholas J. Shaheen, MD, MPH, FACG 1, Gary W. Falk, MD, MS, FACG 2, Prasad G.
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process
Quality ID #249 (NQF 1854): Barrett s Esophagus National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Transfer of Health Information and Interoperability 2019 COLLECTION TYPE:
More informationENDOLUMINAL THERAPIES FOR GERD. University of Colorado Department of Surgery Grand Rounds March 31st, 2008
ENDOLUMINAL THERAPIES FOR GERD University of Colorado Department of Surgery Grand Rounds March 31st, 2008 Overview GERD Healthcare significance Definitions Treatment objectives Endoscopic options Plication
More informationDISCLOSURES. This program meets the requirements for GI specific Category 1 contact hours. M
DISCLOSURES Educational Dimensions is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. Successful completion: Participants
More informationGreater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy
Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy Authors: Dr Gordon Armstrong, Dr Sue Pritchard 1. General Comments 1.1 Cancer reporting: Biopsies
More informationChapter 12: Training in Pathology. DDSEP Chapter 13: Question 19
DDSEP Chapter 13: Question 19 A 70 year-old male with a history of celiac disease diagnosed in his forties reports abdominal pain, dark stools, and 20-pound weight loss. He reports complete compliance
More informationESOPHAGEAL CANCER. Epidemiology 3/22/2017. Esophageal Carcinoma: subtypes. Esophageal Adenocarcinoma (EAC) Epidemiology.
ESOPHAGEAL CANCER Disclosures Sushil Ahlawat, MD, FACP, FASGE, AGAF Associate Professor of Medicine Director of Endoscopy RUTGERS NJMS Nothing to disclose. Esophageal Carcinoma: subtypes Subtype Squamous
More informationSAMs Guidelines DEVELOPING SELF-ASSESSMENT MODULES TEST QUESTIONS. Ver. #
SAMs Guidelines DEVELOPING SELF-ASSESSMENT MODULES TEST Ver. #5-02.12.17 GUIDELINES FOR DEVELOPING SELF-ASSESSMENT MODULES TEST The USCAP is accredited by the American Board of Pathology (ABP) to offer
More informationPatterns of recurrent and persistent intestinal metaplasia after successful radiofrequency ablation of Barrett s esophagus
Patterns of recurrent and persistent intestinal metaplasia after successful radiofrequency ablation of Barrett s esophagus Robert J. Korst, MD, a,b Sobeida Santana-Joseph, MSN, a,b John R. Rutledge, MAS,
More informationCitation for published version (APA): Phoa, K. Y. N. (2014). Endoscopic management of Barrett s esophagus with dysplasia
UvA-DARE (Digital Academic Repository) Endoscopic management of Barrett s esophagus with dysplasia Phoa, Nadine Link to publication Citation for published version (APA): Phoa, K. Y. N. (2014). Endoscopic
More informationRecurrent intestinal metaplasia at the gastroesophageal junction following endoscopic eradication of dysplastic Barrett s esophagus may not be benign
THIEME E849 Recurrent intestinal metaplasia at the gastroesophageal junction following endoscopic eradication of dysplastic Barrett s esophagus may not be benign Authors Georgina R. Cameron 1, 3, Paul
More informationBarrett Esophagus - RadioFrequency Ablation (BE-RFA) - Project manual + FAQ
Barrett Esophagus - RadioFrequency Ablation (BE-RFA) - Project manual + FAQ Table of contents 1 General project information...3 1.1 Inclusion criteria...3 1.2 Registration time points...3 1.3 Project variable
More informationEsophageal cancer: Biology, natural history, staging and therapeutic options
EGEUS 2nd Meeting Esophageal cancer: Biology, natural history, staging and therapeutic options Michael Bau Mortensen MD, Ph.D. Associate Professor of Surgery Centre for Surgical Ultrasound, Upper GI Section,
More informationArchived at the Flinders Academic Commons:
Archived at the Flinders Academic Commons: http://dspace.flinders.edu.au/dspace/ This is the authors version of an article published in Expert Review of Gastroenterology and Hepatology. The original publication
More informationBarrett s Esophagus. lining of the lower esophagus that bears his name (i.e., Barrett's esophagus). We now
Shamika Johnson Anatomy & Physiology 206 April 20, 2010 Barrett s Esophagus What is Barrett s Esophagus? Norman Barrett was a pathologist. In 1950, he described an abnormality in the lining of the lower
More informationSlide 1. Slide 2. Slide 3 DISCLOSURES EXPECTED OUTCOMES DIAGNOSIS AND TREATMENT
Slide 1 DIAGNOSIS AND TREATMENT 1 Slide 2 DISCLOSURES Successful completion: Participants must attend the entire program, including any resulting Q & A, and submit required documentation. Conflict of interest:
More informationThe normal esophagus is lined with squamous epithelium.
.. ALAN J. CAMERON, M.D. In Barrett's esophagus, the squamous lining of the lower esophagus is replaced by columnar epithelium. Barrett's esophagus is associated with gastroesophageal reflux and an increased
More informationGERD DIAGNOSIS & TREATMENT DISCLOSURES 4/18/2018
GERD DIAGNOSIS & TREATMENT Subhash Chandra MBBS Assistant Professor CHI Health Clinic Gastroenterology Creighton University, School of Medicine April 28, 2018 DISCLOSURES None 1 OBJECTIVES Review update
More informationGastrointestinal pathology 2018 lecture 2. Dr Heyam Awad FRCPath
Gastrointestinal pathology 2018 lecture 2 Dr Heyam Awad FRCPath Eosinophilic esophagitis Incidence of eosinophilic gastritis is increasing. Symptoms: food impaction and dysphagia. Histology: infiltration
More informationEsophageal Adenocarcinoma: Pathogenesis, Prevention, and Prognosis
Department of General Thoracic and Esophageal Surgery, Heart and Lung Center Helsinki University Hospital, Helsinki, Finland And Department of Gastrointestinal Surgery, Abdominal Center Helsinki University
More informationEndoscopic therapy of Barrett s esophagus Oliver Pech and Christian Ell
Endoscopic therapy of Barrett s esophagus Oliver Pech and Christian Ell Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany Correspondence to Oliver Pech, MD, PhD, Department of Gastroenterology,
More informationAdenocarcinoma of the distal esophagus is a recognized
ORIGINAL ARTICLE Adenocarcinomas of the Distal Esophagus and Gastric Cardia Are Predominantly Esophageal Carcinomas Parakrama Chandrasoma, MD, Kumari Wickramasinghe, MD, PhD, Yanling Ma, MD, and Tom DeMeester,
More informationEvaluating Treatments of Barrett s Esophagus That Shows High-Grade Dysplasia
...PRESENTATIONS... Evaluating Treatments of Barrett s Esophagus That Shows High-Grade Dysplasia Based on a presentation by Bergein F. Overholt, MD Presentation Summary Thermal ablation and surgery are
More informationIt has been estimated that 5.6% of adults in the United States have
The new england journal of medicine review article Dan L. Longo, M.D., Editor Barrett s Esophagus Stuart J. Spechler, M.D., and Rhonda F. Souza, M.D. From the Esophageal Diseases Center, Department of
More informationTreat Barrett s, Remove the Risk. HALO System
Treat Barrett s, Remove the Risk HALO System The HALO 360 System Advanced Ablation Technology for Barrett s Esophagus The HALO 360 System is designed to remove the Barrett s epithelium in a short, well-tolerated
More informationEarlyoesophagealcancer. dr. Nina Zidar Institute of Pathology Faculty ofmedicine University of Ljubljana Slovenia
Earlyoesophagealcancer dr. Nina Zidar Institute of Pathology Faculty ofmedicine University of Ljubljana Slovenia Early carcinoma of oesophagus = tumor limited to mucosa or submucosa, not extending into
More informationDisclosures. Heartburn and Barrett s Esophagus. Heartburn and Barrett s Esophagus. GERD is common in the U.S. None
Heartburn and Barrett s Esophagus None Disclosures Christian Mathy, MD University of California, San Francisco 2015 Heartburn and Barrett s Esophagus Heartburn and GERD GERD therapy Extraesophageal GERD
More informationGastrooesophageal reflux disease. Jera Jeruc Institute of pathology, Faculty of Medicine, Ljubljana, Slovenia
Gastrooesophageal reflux disease Jera Jeruc Institute of pathology, Faculty of Medicine, Ljubljana, Slovenia Reflux esophagitis (RE) GERD: a spectrum of clinical conditions and histologic alterations resulting
More informationTHE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 97, No. 1, by Am. Coll. of Gastroenterology ISSN /02/$22.00
THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 97, No. 1, 2002 2002 by Am. Coll. of Gastroenterology ISSN 0002-9270/02/$22.00 Published by Elsevier Science Inc. PII S0002-9270(01)03982-X ORIGINAL CONTRIBUTIONS
More informationOpinion Statement. Esophagus (E Dellon, Section Editor)
Curr Treat Options Gastro (2016) 14:1 18 DOI 10.1007/s11938-016-0080-4 Esophagus (E Dellon, Section Editor) Current Controversies in Radiofrequency Ablation Therapy for Barrett s Esophagus Kamar Belghazi,
More information