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Wang D, Chen Y, Ji F, Hu JW, Zhou PH, Xu SC, Chen Y, Ye LP, Ye GL, Li R, Li ZS. Hybrid argon plasma coagulation for the treatment of Barrett’s esophagus: A prospective, multicenter study. World J Clin Cases 2024; 12:3866-3872. [DOI: 10.12998/wjcc.v12.i19.3866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The incidence of Barrett’s esophagus (BE) in China is lower compared to the Western populations. Hence, studies conducted in the Chinese population has been limited. The current treatment options available for BE treatment includes argon plasma coagulation (APC), radiofrequency ablation and cryoablation, all with varying degrees of success.
AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.
METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment. These procedures were performed by seven endoscopists from different tertiary hospitals. The duration of the procedure, curative rate, complications and recurrent rate by 1-year follow-up were recorded.
RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020, comprising of 39 males and 41 females with a median age of 54 years (range, 30 to 83 years). The technical success rate of HybridAPC was 100% and the overall curative rate was 98.15%. No severe complications occurred during the operation. BE cases were classified as short-segment BE and long-segment BE. Patients with short-segment BE were all considered cured without complications. Thirty-six patients completed the one-year follow-up without recurrence. Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment. The mean duration of the procedure was 10.94 ± 6.52 min.
CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up, especially in cases of short-segment BE. This technique could be considered as a feasible alternative ablation therapy for BE.
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Affiliation(s)
- Dong Wang
- Department of Gastroenterology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Yan Chen
- Department of Gastroenterology, Changhai Hospital, Shanghai 200438, China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 311399, Zhejiang Province, China
| | - Jian-Wei Hu
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shu-Chang Xu
- Endoscopy Center, Tongji Hospital of Tongji University, Shanghai 200092, China
| | - Ying Chen
- Endoscopy Center, Tongji Hospital of Tongji University, Shanghai 200092, China
| | - Li-Ping Ye
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou 318001, Zhejiang Province, China
| | - Guo-Liang Ye
- Department of Gastroenterology, The Affiliated Hospital of Medicine School, Ningbo University, Ningbo 315021, Zhejiang Province, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Shanghai 200438, China
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Ryan K, Lowe E, Barker N, Grimpen F. The impact of endoscopic treatment on health-related quality of life in patients with Barrett's neoplasia: a scoping review. Qual Life Res 2024; 33:607-617. [PMID: 37870655 DOI: 10.1007/s11136-023-03528-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE The objective of this scoping review is to understand the extent, type of evidence, and overall findings in relation to the impact of endoscopic treatment (ET) on health-related quality of life (HR-QoL) in patients with Barrett's dysplasia and early oesophageal cancer. METHODS A comprehensive search was conducted for literature between 2001 and 2022 in computerised databases (PubMed, Embase, Cochrane Library, and CINAHL Complete). Additionally, sources of unpublished literature were searched in Google Advanced Search. After title and abstract checking, full-text papers were retrieved. Data were extracted, synthesised, key information tabulated, and a narrative synthesis completed. RESULTS Six studies were included in the final analysis. Twelve different survey tools were utilised across all studies. Study designs included three randomised controlled studies, two prospective observational studies, and a single retrospective observational study. The average age of study participants ranged from 60.3 to 71.0 years. Two studies evaluated HR-QoL as primary outcome measures, but most research evaluated HR-QoL as a secondary outcome. Health domains evaluated in the studies focussed on the biophysical and psychosocial aspects of quality of life. CONCLUSION A small number of research studies have been conducted in this area. Due to the heterogeneity and small number of included studies, it was difficult to draw conclusions about the impact of specific ET types on HR-QoL. Overall, there were perceived psychological benefits while undergoing ET. Future research could target specific ET subtypes and measure HR-QoL at baseline and post-procedures in the short and long term.
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Affiliation(s)
- Kimberley Ryan
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.
- School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Australia.
| | - Erin Lowe
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Natalie Barker
- The University of Queensland, UQ Library, Herston, QLD, 4006, Australia
| | - Florian Grimpen
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
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Ratcliffe E, Britton J, Heal C, Keld R, Murgatroyd M, Willert R, McLaughlin J, Hamdy S, Ang Y. Quality of life measures in dysplastic Barrett's oesophagus are comparable to patients with non-dysplastic Barrett's oesophagus and do not improve after endoscopic therapy. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001091. [PMID: 37041020 PMCID: PMC10105999 DOI: 10.1136/bmjgast-2022-001091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE Barrett's oesophagus (BO) is a precursor lesion, via dysplastic phases, to oesophageal adenocarcinoma. Although overall risk from BO is low, it has been shown to adversely affect health-related quality of life (HRQOL). The aim was to compare dysplastic BO patients' HRQOL pre-endoscopic therapy (pre-ET) and post-ET. The pre-ET BO group was also compared with other cohorts: non-dysplastic BO (NDBO), those with colonic polyps, gastro-oesophageal reflux disease (GORD) and healthy volunteers. DESIGN Participants in the pre-ET cohort were recruited prior to their endotherapy and HRQOL questionnaires provided pre-ET and post-ET. Wilcoxon rank test was used to compare the pre-ET and post-ET findings. The Pre-ET group was compared to the other cohorts' HRQOL results using multiple linear regression analysis. RESULTS Pre-ET group of 69 participants returned the questionnaires prior to and 42 post-ET. Both the pre-ET and post-ET group showed similar levels of cancer worry, despite the treatment. No statistical significance was found for symptoms scores, anxiety and depression or general health measures with the Short Form-36 (SF-36) Score. Education for the BO patients was overall lacking with many of the pre-ET group still reporting unanswered questions about their disease.The Pre-ET group was compared with NDBO group (N=379), GORD (N=132), colonic polyp patients (N=152) and healthy volunteers (N=48). Cancer worry was similar between the NDBO group and the Pre-ET group, despite their lower risk of progression. GORD patients had worse symptom scores from a reflux and heartburn perspective. Only the healthy group has significantly better scores in the SF-36 and improved hospital anxiety and depression scores. CONCLUSION These findings suggest that there is a need to improve HRQOL for patients with BO. This should include improved education and devising-specific patient-reported outcome measures for BO to capture relevant areas of HRQOL in future studies.
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Affiliation(s)
- Elizabeth Ratcliffe
- Gastroenterology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
| | - James Britton
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, Manchester, UK
| | - Calvin Heal
- School of Health Sciences, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Richard Keld
- Gastroenterology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Mark Murgatroyd
- Gastroenterology Department, Bolton NHS Foundation Trust, Bolton, UK
| | - Robert Willert
- Gastroenterology Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, Manchester, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, Manchester, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, Manchester, UK
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van der Ende-van Loon MCM, Stoker A, Nieuwkerk PT, Curvers WL, Schoon EJ. How are we measuring health-related quality of life in patients with a Barrett Esophagus? A systematic review on patient-reported outcome measurements. Qual Life Res 2021; 31:1639-1656. [PMID: 34748137 PMCID: PMC9098608 DOI: 10.1007/s11136-021-03009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
Purpose Barrett esophagus (BE) is associated with a significant decrease of health-related quality of life (HRQoL). Too often, patient-reported outcome measures (PROMs) are applied without considering what they measure and for which purposes they are suitable. With this systematic review, we provide researchers and physicians with an overview of all the instruments previously used for measuring HRQoL in BE patients and which PROMs are most appropriate from the patient’s perspective. Methods A comprehensive search was performed to identify all PROMs used for measuring HRQoL in BE patients, to identify factors influencing HRQoL according to BE patients, and to evaluate each PROM from a patients’ perspective. Results Among the 27 studies, a total of 32 different HRQoL instruments were identified. None of these instruments were designed or validated for use in BE patients. Four qualitative studies were identified exploring factors influencing HRQoL in the perceptions of BE patients. These factors included fear of cancer, anxiety, trust in physician, sense of control, uncertainty, worry, burden of endoscopy, knowledge and understanding, gastrointestinal symptoms, sleeping difficulties, diet and lifestyle, use of medication, and support of family and friends. Conclusion None of the quantitative studies measuring HRQoL in BE patients sufficiently reflected the perceptions of HRQoL in BE patients. Only gastrointestinal symptoms and anxiety were addressed in the majority of the studies. For the selection of PROMs, we encourage physicians and researchers measuring HRQoL to choose their PROMs from a patient perspective and not strictly based on health professionals’ definitions of what is relevant.
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Affiliation(s)
| | - A Stoker
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - P T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - W L Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - E J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,GROW: School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Hussein M, Sehgal V, Sami S, Bassett P, Sweis R, Graham D, Telese A, Morris D, Rodriguez-Justo M, Jansen M, Novelli M, Banks M, Lovat LB, Haidry R. The natural history of low-grade dysplasia in Barrett's esophagus and risk factors for progression. JGH OPEN 2021; 5:1019-1025. [PMID: 34584970 PMCID: PMC8454488 DOI: 10.1002/jgh3.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
Background and Aim Barrett's esophagus is associated with increased risk of esophageal adenocarcinoma. The optimal management of low‐grade dysplasia arising in Barrett's esophagus remains controversial. We performed a retrospective study from a tertiary referral center for Barrett's esophagus neoplasia, to estimate time to progression to high‐grade dysplasia/esophageal adenocarcinoma in patients with confirmed low‐grade dysplasia compared with those with downstaged low‐grade dysplasia from index presentation and referral. We analyzed risk factors for progression. Methods We analyzed consecutive patients with low‐grade dysplasia in Barrett's esophagus referred to a single tertiary center (July 2006–October 2018). Biopsies were reviewed by at least two expert pathologists. Results One hundred and forty‐seven patients referred with suspected low‐grade dysplasia were included. Forty‐two of 133 (32%) of all external referrals had confirmed low‐grade dysplasia after expert histopathology review. Multivariable analysis showed nodularity at index endoscopy (P < 0.05), location of dysplasia (P = 0.05), and endoscopic therapy after referral (P = 0.09) were associated with progression risk. At 5 years, 59% of patients with confirmed low‐grade dysplasia had not progressed versus 74% of patients in the cohort downstaged to non‐dysplastic Barrett's esophagus. Conclusion Our data show variability in the diagnosis of low‐grade dysplasia. The cumulative incidence of progression and time to progression varied across subgroups. Confirmed low‐grade dysplasia had a shorter progression time compared with the downstaged group. Nodularity at index endoscopy and multifocal low‐grade dysplasia were significant risk factors for progression. It is important to differentiate these high‐risk subgroups so that decisions on surveillance/endotherapy can be personalized.
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Affiliation(s)
- Mohamed Hussein
- Division of surgery and interventional science University College London (UCL) London UK.,Department of Gastroenterology University College London Hospital London UK.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) University College London London UK
| | - Vinay Sehgal
- Department of Gastroenterology University College London Hospital London UK
| | - Sarmed Sami
- Department of Gastroenterology University College London Hospital London UK
| | | | - Rami Sweis
- Department of Gastroenterology University College London Hospital London UK
| | - David Graham
- Department of Gastroenterology University College London Hospital London UK
| | - Andrea Telese
- Department of Gastroenterology University College London Hospital London UK
| | - Danielle Morris
- Department of Gastroenterology University College London Hospital London UK
| | | | | | | | - Matthew Banks
- Department of Gastroenterology University College London Hospital London UK
| | - Laurence B Lovat
- Division of surgery and interventional science University College London (UCL) London UK.,Department of Gastroenterology University College London Hospital London UK.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) University College London London UK
| | - Rehan Haidry
- Division of surgery and interventional science University College London (UCL) London UK.,Department of Gastroenterology University College London Hospital London UK.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) University College London London UK
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Reddy CA, Tavakkoli A, Chen VL, Korsnes S, Bedi AO, Carrott PW, Chang AC, Lagisetty KH, Kwon RS, Elmunzer BJ, Orringer MB, Piraka C, Prabhu A, Reddy RM, Wamsteker E, Rubenstein JH. Long-Term Quality of Life Following Endoscopic Therapy Compared to Esophagectomy for Neoplastic Barrett's Esophagus. Dig Dis Sci 2021; 66:1580-1587. [PMID: 32519141 PMCID: PMC8327124 DOI: 10.1007/s10620-020-06377-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Endoscopic therapy (ET) and esophagectomy result in similar survival for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC), but the long-term quality of life (QOL) has not been compared. AIMS We aimed to compare long-term QOL between patients who had undergone ET versus esophagectomy. METHODS Patients were included if they underwent ET or esophagectomy at the University of Michigan since 2000 for the treatment of HGD or T1a EAC. Two validated survey QOL questionnaires were mailed to the patients. We compared QOL between and within groups (ET = 91, esophagectomy = 62), adjusting for covariates. RESULTS The median time since initial intervention was 6.8 years. Compared to esophagectomy, ET patients tended to be older, had a lower prevalence of EAC, and had a shorter duration since therapy. ET patients had worse adjusted physical and role functioning than esophagectomy patients. However, the adjusted odds ratio (OR) of having symptoms was significantly less with ET for diarrhea (0.287; 95% confidence interval [CI] = 0.114, 0.724), trouble eating (0.207; 0.0766, 0.562), choking (0.325; 0.119, 0.888), coughing (0.291; 0.114, 0.746), and speech difficulty (0.306; 0.0959, 0.978). Amongst the ET patients, we found that the number of therapy sessions and need for dilation were associated with worse outcomes. DISCUSSION Multiple measures of symptom status were better with ET compared to esophagectomy following treatment of BE with HGD or T1a EAC. We observed worse long-term physical and role functioning in ET patients which could reflect unmeasured baseline functional status rather than a causal effect of ET.
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Affiliation(s)
- Chanakyaram A Reddy
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Anna Tavakkoli
- Division of Gastroenterology, UT Southwestern, Dallas, TX, USA
| | - Vincent L Chen
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Sheryl Korsnes
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aarti Oza Bedi
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Philip W Carrott
- Division of Thoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kiran H Lagisetty
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard S Kwon
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology, Medical University of South Carolina, Charleston, SC, USA
| | - Mark B Orringer
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Cyrus Piraka
- Division of Gastroenterology, Henry Ford Health System, Detroit, MI, USA
| | - Anoop Prabhu
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Erik Wamsteker
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Joel H Rubenstein
- Barrett's Esophagus Program, Division of Gastroenterology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
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