"No further screening is needed if the initial esophagogastroduodenoscopy (EGD) is negative for BE . The BSG and the French Society of Digestive Endoscopy (FSDE) do not recommend routine screening for BE [9, 42, 71]. Table 4 summarizes guidelines for screening for BE by major professional organizations. "
[Show abstract][Hide abstract] ABSTRACT: The incidence of esophageal adenocarcinoma (EAC) has increased exponentially in the last 3 decades. Barrett's esophagus (BE) is the only known precursor of EAC. Patients with BE have a greater than 40 folds higher risk of EAC compared with the general population. Recent years have witnessed a revolution in the clinical and molecular research related to BE. However, several aspects of this condition remain controversial. Data regarding the true prevalence of BE have varied widely. Recent studies have suggested a lower incidence of EAC in nondysplastic BE (NDBE) than previously reported. There is paucity of prospective data showing a survival benefit of screening or surveillance for BE. Furthermore, the ever-increasing emphasis on healthcare cost containment has called for reexamination of the screening and surveillance strategies for BE. There is a need for identification of reliable clinical predictors or molecular biomarkers to risk-stratify patients who might benefit the most from screening or surveillance for BE. Finally, new therapies have emerged for the management of dysplastic BE. In this paper, we highlight the key areas of controversy and uncertainty surrounding BE. The paper discusses, in detail, the current literature about the molecular pathogenesis, biomarkers, histopathological diagnosis, and management strategies for BE.
Pathology Research International 05/2012; 2012(2090-8091):814146. DOI:10.1155/2012/814146
"Consequently, the current standard of endoscopic practice is to take multiple biopsies because there are no features on standard or HR endoscopy that distinguish Barrett's glandular metaplasia, dysplasia, or early-stage neoplasia. However the accuracy of standard white light endoscopy (WLE) and random biopsies is low and may fail to detect neoplastic lesions . Moreover biopsies obtained using this technique are prone to sampling error, and interobserver agreement is low even between advanced operators and even among expert pathologists "
[Show abstract][Hide abstract] ABSTRACT: Many endoscopic imaging modalities have been developed and introduced into clinical practice to enhance the diagnostic capabilities of upper endoscopy. In the past, detection of dysplasia and carcinoma of esophagus had been dependent on biopsies taken during standard white-light endoscopy (WLE). Recently high-resolution (HR) endoscopy enables us to visualize esophageal mucosa but resolution for glandular structures and cells is still low. Probe-based confocal laser endomicroscopy (pCLE) is a new promising diagnostic technique by which details of glandular and vascular structures of mucosal layer can be observed. However, the clinical utility of this new diagnostic tool has not yet been fully explored in a clinical setting. In this paper we will highlight this new technique for detection of esophageal dysplasia and carcinoma from a clinical practice perspective.
Gastroenterology Research and Practice 03/2012; 2012(2):493961. DOI:10.1155/2012/493961 · 1.75 Impact Factor
"According to the recommendations of the French Society of Digestive Endoscopy, none of new endoscopy techniques (chromoendoscopy, magnification, narrow band imaging, Fuji Intelligent Chromo Endoscopy) can replace multiple biopsies taken according to the Seattle protocol . Despite proven association between pit pattern and histology, our data do not challenge those recommendations. "
[Show abstract][Hide abstract] ABSTRACT: Specialized intestinal metaplasia (SIM) in Barrett's esophagus is a risk factor of esophageal adenocarcinoma. It often occurs focally and cannot be distinguished from surrounding columnar epithelium with conventional endoscopy.
The purpose of this study was evaluation of methylene blue (MB) staining and magnification endoscopy with comparison of pit-pattern classifications according to Endo and Guelrud, in detection of SIM in Barrett's esophagus.
Twenty-five patients, aged 33-77 years (average 57 years), with displacement of Z line were prospectively enrolled and underwent gastroscopy with the use of magnification up to 115 times (Olympus GIF Q160Z). Biopsy for histopathologic examination was taken from sites stained with MB and/or places with particular pit patterns. A control group consisted of ten patients with normal gastro-esophageal junction.
SIM was proved in nine patients, and significantly more frequently in patients with hiatal hernia and Barrett's segment longer than 3 cm. Round or thin linear pit patterns according to Guelrud's and small round and straight pit patterns according to Endo's classification were coupled with columnar epithelium. SIM was associated with deep linear and foveolar pit patterns in Guelrud's classification. Other pit patterns were less characteristic. Both classifications had high sensitivity (Endo's 85.7%, Guelrud's 92.8%) but poor specificity (respectively, 21.15 and 28.4%) in detection of SIM. Sensitivity and specificity of MB staining were, respectively, 71.4 and 40.6%.
Despite existing association between mucosal surface structure and histology, we find no convincing data indicating that pit-pattern evaluation may replace multiple biopsies taken according to recommendations from Seattle for detection of SIM in Barrett's esophagus.
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