Amit Rastogi

University of Missouri - Kansas City, Kansas City, Missouri, United States

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Publications (148)1057.8 Total impact

  • 01/2015; 13(1):6-10.e1.
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    ABSTRACT: Diminutive (≤5 mm) colorectal polyps are common, and overwhelmingly benign. Routinely, after polypectomy, they are examined pathologically to determine the surveillance intervals. Advances in equipment and techniques, such as narrow-band imaging (NBI) colonoscopy, now permit reliable real-time optical diagnosis.
    Gut 11/2014; · 10.73 Impact Factor
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    ABSTRACT: Objective The aim of the study was to evaluate the impact of computer based teaching module on the performance of community gastroenterologists for characterization of diminutive polyps (≤ 5 mm) using narrow band imaging video clips.Methods80 videos were distributed in pre and posttest DVDs along with a 20-minute audiovisual power point teaching presentation detailing endoscopic features differentiating adenomas from hyperplastic polyps using narrow band imaging. Each participant first reviewed pretest video clips and entered their responses for polyp histology and the confidence in diagnosis: high - ≥90% or low - <90%. Following this, they reviewed the teaching module and assessed the posttest videos. Performance characteristics were calculated for pre and posttest by comparing predicted histology with actual histology. Fisher's exact test was used for analysis and kappa statistic was calculated for interobserver agreement.Results15 gastroenterologists in community practice completed the study. Sensitivity, specificity, accuracy and negative predictive value in characterization of polyp histology improved significantly in posttest compared to pretest. In post test, accuracy was 92% for high confidence diagnoses and proportion of these increased with training from 46% (pretest) to 64% (posttest); p<0.001. Interobserver agreement for diagnosis improved from fair (kappa = 0.23) in pre test to moderate (kappa = 0.56) in posttest.ConclusionsA teaching module using video clips can be used to teach community gastroenterologists polyp histology characterization by narrow band imaging. Whether this translates into real time high accuracy in polyp detection needs to be further evaluated.
    Digestive Endoscopy 11/2014; · 1.61 Impact Factor
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    ABSTRACT: OBJECTIVES:The Paris classification is an international classification system for describing polyp morphology. Thus far, the validity and reproducibility of this classification have not been assessed. We aimed to determine the interobserver agreement for the Paris classification among seven Western expert endoscopists.METHODS:A total of 85 short endoscopic video clips depicting polyps were created and assessed by seven expert endoscopists according to the Paris classification. After a digital training module, the same 85 polyps were assessed again. We calculated the interobserver agreement with a Fleiss kappa and as the proportion of pairwise agreement.RESULTS:The interobserver agreement of the Paris classification among seven experts was moderate with a Fleiss kappa of 0.42 and a mean pairwise agreement of 67%. The proportion of lesions assessed as "flat" by the experts ranged between 13 and 40% (P<0.001). After the digital training, the interobserver agreement did not change (kappa 0.38, pairwise agreement 60%).CONCLUSIONS:Our study is the first to validate the Paris classification for polyp morphology. We demonstrated only a moderate interobserver agreement among international Western experts for this classification system. Our data suggest that, in its current version, the use of this classification system in daily practice is questionable and it is unsuitable for comparative endoscopic research. We therefore suggest introduction of a simplification of the classification system.Am J Gastroenterol advance online publication, 21 October 2014; doi:10.1038/ajg.2014.326.
    The American Journal of Gastroenterology 10/2014; · 9.21 Impact Factor
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    ABSTRACT: Background and study aims: The learning curve for optical diagnosis of colorectal polyps with the narrow-band imaging (NBI) is unknown. To forego histological analysis of diminutive polyps diagnosed optically with high confidence, guidelines recommend ≥ 90 % negative predictive value (NPV) and concordance of ≥ 90 % for surveillance intervals predicted optically and histologically. We aimed to study the learning of optical diagnosis for colorectal polyps. Patients and methods: We studied five endoscopists as part of a randomized multisite trial comparing near-focus and standard-focus views for optical diagnosis. They trained using a computer-based module, followed by 10 real-time colonoscopies with pathology correlation. Endoscopists then optically diagnosed and resected all the polyps found during 558 consecutive colonoscopies, and diagnoses were compared with pathology. Endoscopists repeated the training module at the study midpoint. NPV and concordance of surveillance intervals for diminutive polyps diagnosed optically with high confidence were measured over time. Results: Endoscopists showed high diagnostic performance, with a nonsignificant trend toward higher NPV in the second half of the study. For the 445 polyps in the standard-view arm, the NPV was 88.0 % (95 %CI 75.7 % - 95.5 %) in the first half and 95.8 % (88.3 % - 99.1 %) in the second; P = 0.7. Three endoscopists in the first half and four in the second achieved > 90 % NPV. Concordance of surveillance intervals was identical in the first and second halves at 98.1 % (95 %CI 93.3 % - 99.8 %). Conclusions: High NPV for the prediction of non-neoplasms with NBI was achieved and maintained in this group of endoscopists who participated in standardized and continued training. Both NPV and surveillance interval agreement indicated high performance in the optical diagnosis of colorectal polyps and exceeded thresholds.
    Endoscopy 09/2014; · 5.74 Impact Factor
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    ABSTRACT: BACKGROUND The advantages of endoscopic ultrasound (EUS) and computed tomography (CT)–positron emission tomography (PET) with respect to survival for esophageal cancer patients are unclear. This study aimed to assess the effects of EUS, CT-PET, and their combination on overall survival with respect to cases not receiving these procedures.METHODS Patients who were ≥66 years old when diagnosed with esophageal cancer were identified in the Surveillance, Epidemiology, and End Results–Medicare linked database. Cases were split into 4 analytic groups: EUS only (n = 318), CT-PET only (n = 853), EUS+CT-PET (n = 189), and no EUS or CT-PET (n = 2439). Survival times were estimated with the Kaplan-Meier method and were compared with the log-rank test for each group versus the no EUS or CT-PET group. Multivariate Cox proportional hazards models were used to compare 1-, 3-, and 5-year survival rates.RESULTSKaplan-Meier analyses showed that EUS, CT-PET, and EUS+CT-PET patients had improved survival for all stages (with the exception of stage 0 disease) in comparison with patients undergoing no EUS or CT-PET. Receipt of EUS increased the likelihood of receiving endoscopic therapies, esophagectomy, and chemoradiation. Multivariate Cox proportional hazards models showed that receipt of EUS was a significant predictor of improved 1- (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.39-0.59; P < .0001), 3- (HR, 0.57; 95% CI, 0.48-0.66; P < .0001), and 5-year survival (HR, 0.59; 95% CI, 0.50-0.68). Similar results were noted when the results were stratified on the basis of histology and for the CT-PET and EUS+CT-PET groups.CONCLUSIONS Receipt of either EUS or CT-PET alone in esophageal cancer patients was associated with improved 1-, 3-, and 5-year survival. Future studies should identify barriers to the dissemination of these staging modalities. Cancer 2014. © 2014 American Cancer Society.
    Cancer 09/2014; · 5.20 Impact Factor
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    ABSTRACT: Next generation sequencing (NGS) is a state of the art technology for microRNA (miRNA) analysis. The quantitative interpretation of the primary output of NGS i.e. the read counts for a miRNA sequence that can vary by several orders of magnitude (1 to 107) remains incompletely understood. NGS (SOLiD 3 technology) was performed on biopsies from 6 Barrett's esophagus (BE) and 5 Gastroesophageal Reflux Disease (GERD) patients. Read sequences were aligned to miRBase 18.0. Differential expression analysis was adjusted for false discovery rate of 5%. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed for 36 miRNA in a validation cohort of 47 patients (27 BE and 20 GERD). Correlation coefficients, accuracy, precision and recall of NGS compared to qRT-PCR were calculated. Increase in NGS reads was associated with progressively lower Cq values, p < 0.05. Although absolute quantification between NGS reads and Cq values correlated modestly: -0.38, p = 0.01 for BE and -0.32, p = 0.05 for GERD, relative quantification (fold changes) of miRNA expression between BE &GERD by NGS correlated highly with qRT-PCR 0.86, p = 2.45E-11. Fold change correlations were unaffected when different thresholds of NGS read counts were compared (>1000 vs. <1000, >500 vs. <500 and >100 vs. <100). The accuracy, precision and recall of NGS to label a miRNA as differentially expressed were 0.71, 0.88 and 0.74 respectively. Absolute NGS reads correlated modestly with qRT-PCR but fold changes correlated highly. NGS is robust at relative but not absolute quantification of miRNA levels and accurate for high-throughput identification of differentially expressed miRNA.
    BMC Research Notes 04/2014; 7(1):212.
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    ABSTRACT: To evaluate whether participation of a gastroenterology trainee had an impact on adenoma detection rate (ADR) during screening colonoscopies performed with standard-definition colonoscopes (SD-C) versus high-definition colonoscopes (HD-C). ADR is an established quality indicator of colonoscopy and efforts to improve ADR have led to technological advancements including HD-C that have a greater angle of view and produce an image with higher pixel density compared with SD-C. Moreover, other factors like trainee participation have been shown to improve adenoma detection. This is a retrospective review of screening colonoscopies performed during 2 different time periods by 4 experienced endoscopists with or without trainee participation. There are 2 arms of this study, based on whether screening colonoscopy was performed using SD-C or HD-C. Detailed review of endoscopy and histopathologic reports was conducted. Statistical analysis was performed and odds ratio and incidence rate ratios were calculated to adjust for numerous factors. No significant differences were seen with trainee participation in the SD-C arm of the study. In the HD-C arm, the total number, and the proportion of subjects with: adenomas, diminutive adenomas, and right-sided adenomas were significantly higher with trainee participation. Trainee participation significantly improved the overall adenoma detection, specifically diminutive adenoma and right-sided adenoma detection, but only when colonoscopies were performed with HD-C. The improved image quality and resolution provided by HD-C, coupled with enhanced visual scanning an additional pair of eyes provides, may account for the differential impact of trainee participation on ADR.
    Journal of clinical gastroenterology 01/2014; · 2.21 Impact Factor
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    ABSTRACT: Patient outcomes for esophageal adenocarcinoma (EAC) have not improved despite huge advances in endoscopic therapy because cancers are being diagnosed late. Barrett's esophagus (BE) is the primary precursor lesion for EAC, and thus the non-endoscopic molecular diagnosis of BE can be an important approach to improve EAC outcomes if robust biomarkers for timely diagnosis are identified. MicroRNAs (miRNAs) are tissue-specific novel biomarkers that regulate gene expression and may satisfy this requirement. Patients with gastroesophageal reflux disease (GERD) and BE were selected from an ongoing tissue and serum repository. BE was defined by the presence of intestinal metaplasia. Previously published miRNA sequencing profiles of GERD and BE patients allowed us to select three miRNAs, miR-192-5p, -215-5p, and -194-5p, for further testing in a discovery cohort and an independent validation cohort. Receiver operating curves were generated to calculate the diagnostic accuracy of these miRNAs for BE diagnosis. To test specificity, the miRNA signature was compared with those of the gastric cardia epithelium and the non-intestinal-type columnar epithelium (another definition of BE). In addition, to gain insights into BE origin (intestinal vs non-intestinal), global BE miRNA profiles were compared with the published miRNA profiles of other columnar epithelia in the gastrointestinal tract, that is, normal stomach and small and large intestine. The discovery cohort included 67 white male patients (40 with GERD and 27 with BE). The validation cohort included 28 patients (19 with GERD and 11 with BE). In the discovery cohort, the sensitivity, specificity and area under the curve (AUC) of the three mRNAs for BE diagnosis were 92-100%, 94-95%, and 0.96-0.97, respectively. During validation, the sensitivity and specificity of miRNAs for BE diagnosis were as follows: miR-192-5p, 92% and 94%, AUC 0.94 (0.80-0.99, P=0.0004); miR-215-5p, 100% and 94%, AUC 0.98 (0.84-1, P=0.0004); and miR-194-5p, 91% and 94%, AUC 0.96 (0.80-0.99, P=0.0001), respectively. The tested miRNAs identified all BE patients in both the discovery and the validation cohorts. When compared with non intestinal-type columnar and gastric cardia epithelia, the miRNA signature was specific to the intestinal-type columnar epithelium. Comparisons of BE miRNA sequencing data to published data sets for the normal stomach, small intestine and large intestine confirmed that two of the three miRNAs (miR-215-5p and -194-5p) were specific to the intestinal-type epithelium. MicroRNAs are highly accurate for detecting intestinal-type BE epithelia and should be tested further for the non-endoscopic molecular diagnosis of BE.
    Clinical and translational gastroenterology. 01/2014; 5:e65.
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    ABSTRACT: Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett's oesophagus (BO) is unclear.
    United European gastroenterology journal. 12/2013; 1(6):430-7.
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    ABSTRACT: Universal agreement on the inclusion of intestinal metaplasia to diagnose Barrett's esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64 ± 12 vs. 60 ± 11 years, P = 0.001; whites 92% vs. 82%, P = 0.001; males 99.7% vs. 99.3%, P = NS; CLE length 3.4 ± 3.2 vears 1.4 ± 0.4 cm, P = 0.001 and hiatus hernia 64% vs. 56%, P = 0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P = 0.007) and 4.2-fold (95% CI 1.4-13, P = 0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P = 0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE.
    Diseases of the Esophagus 10/2013; · 1.64 Impact Factor
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    M Singh, A Rastogi
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    ABSTRACT: Endoscopic resection of large colon polyps should be preferred over a surgical approach as it is less invasive. However, endoscopic mucosal resection of large colon polyps can be technically challenging for the endoscopist. The technique of large polypectomy has been evolving with advances in endoscopy equipment, imaging, and the use of techniques such as raising the polyp by submucosal injection and performing polypectomy in the retroflexed position. In this article, some important aspects of the technique for endoscopic resection of a large flat colon polyp are demonstrated. This article is part of an expert video encyclopedia.
    Video Journal and Encyclopedia of GI Endoscopy. 10/2013; 1(2):340–342.
  • Sachin Wani, Amit Rastogi
    Gastrointestinal endoscopy 10/2013; 78(4):633-6. · 6.71 Impact Factor
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    M Singh, A Rastogi
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    ABSTRACT: Endoscopic resection of large pedunculated colon polyps should be preferred over surgical resection; however, it carries the risk of associated significant postpolypectomy bleeding. With advances in endoscopic tools such as endoclips and endoloops, it has become safer to perform endoscopic resection of large pedunculated polyps. Herein are demonstrated some important aspects of the technique for endoscopic resection of a large pedunculated colon polyp. This article is part of an expert video encyclopedia.
    Video Journal and Encyclopedia of GI Endoscopy. 10/2013; 1(2):323–324.
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    ABSTRACT: Outcome data comparing endoscopic eradication therapy (EET) and esophagectomy are limited in patients with early esophageal cancer (EC). To compare overall survival and EC-related mortality in patients with early EC treated with EET and esophagectomy. Population-based study. Patients with early EC (stages T0 and T1) were identified from the Surveillance, Epidemiology, and End Results database (1998-2009). Demographics, tumor specific data, and survival were compared. Cox proportional hazards regression models were used to evaluate the association between treatment and EC-specific mortality. EET and esophagectomy. Mid- (2 years) and long- (5 years) term overall survival and EC-specific mortality, outcomes based on histology and stage, treatment patterns, and predictors of cancer-specific mortality. A total of 430 (21%) and 1586 (79%) patients underwent EET and esophagectomy, respectively. There was no difference in the 2-year (EET: 10.5% vs esophagectomy: 12.7%, P = .27).and 5-year (EET: 36.7% vs esophagectomy: 42.8%, P = .16) EC-related mortality rates between the 2 groups. EET patients had higher mortality rates attributed to non-EC causes (5 years: 46.6% vs 20.6%, P < .001). Similar results were noted when comparisons were limited to patients with stage T0 and T1a disease and esophageal adenocarcinoma. There was no difference in EC-specific mortality in the EET compared with the surgery group (hazard ratio 1.4; 95% confidence interval, 0.9-2.03). Variables associated with mortality were older age, year of diagnosis, radiation therapy, higher stage, and esophageal squamous cell carcinoma. Comorbidities and recurrence rates were not available. This population-based study demonstrates comparable mid- and long-term EC-related mortality in patients with early EC undergoing EET and surgical resection.
    Gastrointestinal endoscopy 09/2013; · 6.71 Impact Factor
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    ABSTRACT: Experts can accurately characterize the histology of diminutive polyps with narrow-band imaging (NBI). There are limited data on the performance of non-experts. To assess the impact of a computer-based teaching module on the accuracy of predicting polyp histology with NBI by non-experts (in academics and community practice) by using video clips. Prospective, observational study. Academic and community practice. A total of 15 gastroenterologists participated-5 experts in NBI, 5 non-experts in academic practice, and 5 non-experts in community practice. Participants reviewed a 20-minute, computer-based teaching module outlining the different NBI features for hyperplastic and adenomatous polyps. Performance characteristics in characterizing the histology of diminutive polyps with NBI by using short video clips before (pretest) and after (posttest) reviewing the teaching module. Non-experts in academic practice showed a significant improvement in the sensitivity (54% vs 79%; P < .001), accuracy (64% vs 81%; P < .001), and proportion of high-confidence diagnoses (49% vs 69%; P < .001) in the posttest. Non-experts in community practice had significantly higher sensitivity (58% vs 75%; P = .004), specificity (76% vs 90%; P = .04), accuracy (64% vs 81%; P < .001), and proportion of high-confidence diagnoses (49% vs 72%; P < .001) in the posttest. Performance of experts in NBI was significantly better than both non-experts in academic and community practice. Selection bias in selecting good quality videos. Performance not assessed during live colonoscopy. Academic and community gastroenterologists without prior experience in NBI can achieve significant improvements in characterizing diminutive polyp histology after a brief computer-based training. The durability of these results and applicability in every day practice are uncertain.
    Gastrointestinal endoscopy 09/2013; · 6.71 Impact Factor
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    ABSTRACT: Previously developed novel probe-based confocal laser endomicroscopy (pCLE) criteria have been found to have high accuracy and substantial interobserver agreement (IOA) for diagnosing dysplasia in Barrett's esophagus (BE) when used by endoscopists. These updated criteria are: (i) epithelial surface: saw toothed, (ii) cells: enlarged, (iii) cells: pleomorphic, (iv) glands: not equidistant, (v) glands: unequal in size and shape, and (vi) goblet cells: not easily identified. The accuracy and IOA among pathologists in the diagnosis of dysplasia using the novel pCLE criteria is not known. The primary objective of the study was to evaluate the accuracy, overall IOA and learning curve among three gastrointestinal (GI) pathologists in diagnosing dysplasia in BE using the updated pCLE criteria. The secondary aim was to compare the accuracy and IOA between GI pathologists and gastroenterology endoscopists. Ninety pCLE videos and respective histology were retrieved from a previously conducted multicenter, prospective, randomized, controlled trial evaluating the utility of pCLE in BE patients. Videos were obtained from 101 BE patients previously enrolled for surveillance or endoscopic treatment of high-grade dysplasia or early esophageal adenocarcinoma. Three GI pathologists reviewed 90 pCLE video clips for dysplasia versus no dysplasia, confidence in their diagnosis, and image quality. The overall accuracy for the diagnosis of dysplasia (low-grade dysplasia/high-grade dysplasia/esophageal adenocarcinoma) was 77.8% (95% confidence interval [CI]: 72.4-82.3). The accuracy was higher when pathologists had 'high confidence' in their assessment of the videos (93.8% vs. 69.3%, P < 0.001). There was no significant difference in accuracy between the first set of 30 and second set of 60 videos (84% vs. 74%, P = 0.065). IOA among GI pathologists was substantial, k = 0.65 (95% CI: 0.53-0.73). The sensitivity for detecting dysplasia was 85% (95% CI: 78.1-90.7) and the specificity was 70% (95% CI: 61.91-77.92). These results were comparable with the evaluation of the same set of videos by endoscopists. GI pathologists have high accuracy and substantial IOA for diagnosing BE dysplasia with pCLE. Pathologists appear to have similar accuracy and IOA as endoscopists. These results provide further support of endoscopists accurately interpreting the in vivo optical histology provided by pCLE.
    Diseases of the Esophagus 09/2013; · 1.64 Impact Factor
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    ABSTRACT: BACKGROUND: Endoscopic management of Barrett's esophagus (BE) has evolved over the past decade; however, the practice patterns for managing BE among gastroenterologists remain unclear. OBJECTIVE: To assess practice patterns for management of BE among gastroenterologists working in various practice settings. DESIGN: A random questionnaire-based survey of practicing gastroenterologists in the United States. The questionnaire contained a total of 10 questions pertaining to practice setting, physician demographics, and strategies used for managing BE. SETTING: Survey of gastroenterologists working in various practice settings. INTERVENTION: Questionnaire. MAIN OUTCOME MEASUREMENTS: Practice patterns for endoscopic imaging and management of BE. RESULTS: The response rate was 45% (236/530). The majority (85%) were gastroenterologists in community practice, 72% were aged 41 to 60 years, 80% had >10 years of experience, and 81% had attended postgraduate courses and/or seminars on BE management. A total of 78% did not use the Prague C & M classification, and about a third used advanced endoscopic imaging routinely (37%) or in selected cases (31%). For nondysplastic BE, 86% practiced surveillance, 12% performed ablation, and 3% did no intervention. For BE with low-grade dysplasia, 56% practiced surveillance, 26% performed endoscopic ablation in all low-grade dysplasia cases, and 18% performed endoscopic ablation in only selected patients with low-grade dysplasia. The majority of respondents (58%) referred their patients with high-grade dysplasia to centers with BE expertise, 13% performed endoscopic ablation in all patients with high-grade dysplasia, 25% performed endoscopic ablation in selected cases only, and 3% referred these patients for surgery. The most frequently used endoscopic eradication therapy was radiofrequency ablation (39%) followed by EMR (17%). LIMITATIONS: The sample may be unrepresentative, participation in the study was voluntary, and responses may be skewed toward following the guidelines. CONCLUSION: Results from this survey show that the majority of practicing gastroenterologists in the United States practice surveillance endoscopy in patients with nondysplastic BE and provide endoscopic therapy for those with high-grade dysplasia. The Prague C & M classification and advanced imaging techniques are used by less than a third of gastroenterologists. Practice patterns did not appear to be affected by respondent age or duration of clinical practice.
    Gastrointestinal endoscopy 06/2013; · 6.71 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: Recent population-based studies have demonstrated a low risk of esophageal adenocarcinoma (EAC) among patients with non-dysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with BE. METHODS: We performed a multicenter outcomes study of a large cohort of BE patients. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in Group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE in their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE in 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against cancer development. RESULTS: Of a total of 3515 BE patients, 1401 patients met the inclusion criteria (93.3% Caucasian, 87.5 % men, median age 60±17 y). The median follow-up was 5±3.9 y (7846 patient-years). The annual risks of EAC in groups 1-5 were 0.32%, 0.27%, 0.16%, 0.2%, and 0.11% respectively (P for trend=.03). After adjusting for age, sex, and BE length, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood for progression to EAC. CONCLUSION: Persistence of NDBE over several endoscopic examinations identifies patients who are at a low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.
    Gastroenterology 05/2013; · 12.82 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: It is not clear whether length of Barrett's esophagus (BE) is a risk factor for high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with non-dysplastic BE (NDBE). We studied the risk of progression to HGD or EAC in patients with NDBE, based on segment length. METHODS: We analyzed data from large cohort of patients participating in the BE Study-a multicenter outcomes project comprising 5 US tertiary care referral centers. Histologic changes were graded as low-grade dysplasia (LGD), HGD, or EAC. The study included patients with BE of documented length without dysplasia and at least 1 y of follow up (n=1175, 88% male) and excluded patients who developed HGD or EAC within 1 y of diagnosis of BE. The mean follow-up period was 5.5 y (6463 patient-y). Annual risk of HGD and EAC was plotted in 3 cm increments (≤3 cm, 4-6 cm, 7-9 cm, 10-12 cm, and ≥13 cm). We calculated the association between time to progression and length of BE. RESULTS: The mean length of BE length was 3.6 cm; 44 patients developed HGD or EAC, with an annual incidence rate of 0.67%/y. Compared to non-progressors, patients who developed HGD or EAC had longer BE (6.1 vs 3.5 cm; P<.001). Logistic regression analysis showed a 28% increase in risk of HGD or EAC for every 1 cm increase in BE length (P=.01). Patients with BE segment lengths ≤3 cm took longer to develop HGD or EAC than those with lengths >4 cm (6 y vs 4 y; P= non-significant) CONCLUSION: In patients with BE without dysplasia, length of BE is associated with progression to HGD or EAC. The results support for development of risk stratification scheme for these patients based on length of BE segment.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2013; · 5.64 Impact Factor

Publication Stats

1k Citations
1,057.80 Total Impact Points

Institutions

  • 2012–2014
    • University of Missouri - Kansas City
      • Veterans Affairs Medical Center
      Kansas City, Missouri, United States
  • 2006–2014
    • University of Kansas
      • • School of Medicine
      • • Department of Pathology
      • • Division of Gastroenterology, Hepatology and Motility
      Lawrence, Kansas, United States
  • 2013
    • United States Department of Veterans Affairs
      Bedford, Massachusetts, United States
    • Washington University in St. Louis
      • Division of Gastroenterology
      Saint Louis, MO, United States
  • 2009–2013
    • Kansas City VA Medical Center
      Kansas City, Missouri, United States
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2007–2013
    • Kansas City University of Medicine and Biosciences
      • Department of Pathology
      Kansas City, Missouri, United States