French Society of Digestive Endoscopy SFED guideline: monitoring of patients with Barrett's esophagus.

Endoscopy (Impact Factor: 5.2). 10/2007; 39(9):840-2. DOI: 10.1055/s-2007-966653
Source: PubMed
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    ABSTRACT: GERD and its potential complications of Barrett’s oesophagus and oesophageal adenocarcinoma are now the most important disease processes for oesophageal surgeons. A major impact on this disease will likely come from the development of cost-effective screening and diagnostic modalities which identify patients who are at risk for developing oesophageal cancer. The surgical approach to Barrett’s oesophagus and oesophageal adenocarcinoma will continue to evolve in response to advances in ablative therapy and ER. The role of the pathologist, with expertise in the diagnosis of Barrett’s oesophagus, will become more prominent as we better define the histological predictors of oesophageal adenocarcinoma. A collaborative effort between pathologists and surgeons is essential in determining the timing and best approach for interventional therapy.
    Journal of Clinical Pathology 08/2014; 67(10). DOI:10.1136/jclinpath-2014-202518 · 2.55 Impact Factor
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    ABSTRACT: This paper reviews the role of low-grade dysplasia (LGD) as a marker of progression in Barrett's oesophagus (BO). Albeit with its limits due to the difficulty of its diagnosis and the low agreement among pathologists, LGD remains the most relevant single prognostic factor of progression, and, when the diagnosis is confirmed by two or three pathologists, the chances of progression to high-grade dysplasia or invasive adenocarcinoma are as high as 40 %. On the other hand, BO patients who remain dysplasia free at several follow-up examinations seem to have a very low likelihood of progression. The diagnosis of LGD should be confirmed by two pathologists, and surveillance programs should be tailored depending on the presence or persistent absence of LGD. Ablative therapy should be also considered for cases where LGD persists in a series of follow-ups.
    World Journal of Surgery 06/2014; 39(3). DOI:10.1007/s00268-014-2661-5 · 2.35 Impact Factor
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    ABSTRACT: Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) are considered as precursors of colorectal cancer, and are often diagnostic challenges. Their true prevalence is masked by significant inter-observer variations. To investigate the true prevalence and synchronous colorectal carcinoma (sCRC) of colorectal serrated polyps (CSP) and their associated factors, we first retrospectively identified all colorectal polyps collected at our institution between June 1995 and May 2013. After centrally reclassifying all CSP to reduce inter-observer variations, Chi-square tests and logistic regression analyses were used to analyze the potential factors. Among the included 5501 colorectal polyps, 499 CSP of 428 patients were identified and studied, including 353 hyperplastic polyps (HP, 70.7%), 80 SSA (16.0%), 61 TSA (12.2%) and 5 mixed polyp (1.0%). Diagnostic disagreements were found in 68 CSP (13.63% of CSP). SSA and TSA were more often larger than 5 mm and in proximal colon than HP. SSA were also more likely associated with older age (p=0.005), size ≥5 mm (p<0.001) and ≥3 polyps (p=0.004) than HP in distal colon, but only more likely associated with older age (p=0.006) in proximal colon. Multivariate regression analysis demonstrated that CSP with sCRC, compared with CSP without sCRC, were linked to CSP size ≥1 cm (vs <1 cm, odds ratio [OR] 4.412, 95% confidence interval [CI] 1.684-11.556, P=0.003) and a diagnosis of SSA or TSA (vs HP, OR 6.194, 95% CI 1.870-20.513, P=0.003 and OR 6.754, 95% CI 1.981-23.028, P=0.002, respectively), but not age, gender, polyp number and polyp shape. SSA and TSA are similarly often associated with sCRC (P=0.460). In conclusion, histology subtypes and polyp size may serve as markers for sCRC of CSP. SSA and TSA may warrant careful endoscopic examinations and similar follow-up intervals.