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Iwaya Y, Goda K, Kako S, Hattori H, Miyazawa T, Hara D, Hashigami K, Hirayama A, Okamura T, Nagaya T, Umemura T. Association between endoscopic evidence of bile reflux and Barrett's esophagus: A large-scale case-control study. Dig Liver Dis 2024; 56:622-627. [PMID: 38105146 DOI: 10.1016/j.dld.2023.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/02/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Although bile reflux plays an important role in the development of Barrett's esophagus, the relationship between endoscopic findings of bile reflux and Barrett's esophagus remains unclear. OBJECTIVE This study evaluated whether endoscopic evidence of bile reflux was associated with the presence of Barrett's esophagus. METHODS A retrospective analysis of a prospectively maintained database comprising consecutive patients who underwent screening esophagogastroduodenoscopy was conducted. Endoscopic evidence of bile reflux was defined as the presence of bile-stained fluid in the gastric fundus. We performed multivariate analysis to identify predictive factors that differed significantly between patients with and without Barrett's esophagus. RESULTS Of 4021 patients, 922 (23%) had Barrett's esophagus, and 1000 (25%) showed endoscopic findings of bile reflux. Multivariate analysis revealed endoscopic evidence of bile reflux as the strongest independent factor associated with the presence of Barrett's esophagus (odds ratio [OR] 5.65, 95% confidence interval [CI] 4.71-6.76) in relation to the presence of hiatal hernia (OR 3.30, 95% CI 2.70-4.04) and male gender (OR 1.54, 95% CI 1.24-1.91). CONCLUSIONS Endoscopic evidence of bile reflux was independently associated with the presence of Barrett's esophagus. This finding might help identify patients at future risk of Barrett's esophagus who could benefit from increased endoscopy surveillance.
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Affiliation(s)
- Yugo Iwaya
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan; Department of Advanced Therapeutic Endoscopy, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Kenichi Goda
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Satoko Kako
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Honoka Hattori
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takayuki Miyazawa
- Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daichi Hara
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenta Hashigami
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Atsuhiro Hirayama
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuma Okamura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Endoscopic Examination Center, Shinshu University Hospital, Matsumoto, Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan; Department of Advanced Therapeutic Endoscopy, Shinshu University School of Medicine, Matsumoto, Japan
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Li N, Jin SZ. Artificial intelligence and early esophageal cancer. Artif Intell Gastrointest Endosc 2021; 2:198-210. [DOI: 10.37126/aige.v2.i5.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
The development of esophageal cancer (EC) from early to advanced stage results in a high mortality rate and poor prognosis. Advanced EC not only poses a serious threat to the life and health of patients but also places a heavy economic burden on their families and society. Endoscopy is of great value for the diagnosis of EC, especially in the screening of Barrett’s esophagus and early EC. However, at present, endoscopy has a low diagnostic rate for early tumors. In recent years, artificial intelligence (AI) has made remarkable progress in the diagnosis of digestive system tumors, providing a new model for clinicians to diagnose and treat these tumors. In this review, we aim to provide a comprehensive overview of how AI can help doctors diagnose early EC and precancerous lesions and make clinical decisions based on the predicted results. We analyze and summarize the recent research on AI and early EC. We find that based on deep learning (DL) and convolutional neural network methods, the current computer-aided diagnosis system has gradually developed from in vitro image analysis to real-time detection and diagnosis. Based on powerful computing and DL capabilities, the diagnostic accuracy of AI is close to or better than that of endoscopy specialists. We also analyze the shortcomings in the current AI research and corresponding improvement strategies. We believe that the application of AI-assisted endoscopy in the diagnosis of early EC and precancerous lesions will become possible after the further advancement of AI-related research.
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Affiliation(s)
- Ning Li
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
| | - Shi-Zhu Jin
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China
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McGoran JJ, Ragunath K. Endoscopic management of Barrett's esophagus: Western perspective of current status and future prospects. Dig Endosc 2021; 33:720-729. [PMID: 32790886 DOI: 10.1111/den.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma and current practice is to establish endoscopic surveillance once diagnosed, in order to identify early dysplasia and neoplasia that has the potential to undergo endoscopic eradication therapy (EET). Before embarking upon EET the clinical team has a duty to consider all viable options and come to a plan based on recent evidence. The therapeutic approach varies greatly but largely adheres to the mantra of 'Detect-Resect-Ablate', in which high-quality endoscopy identifies BE associated pathology, associated lesions (if present) undergo safe endoscopic resection and remaining intestinal metaplasia in the esophagus is ablated to prevent recurrence of dysplasia. In this review, current practice, pitfalls, complications, and the future perspectives on practice in this field are discussed. The Western perspective is focused on here, with an outline of the differences in clinical practice with Asian nations and attempts to bridge these differences.
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Affiliation(s)
- John J McGoran
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Krish Ragunath
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia.,Curtin University Medical School, Perth, WA, Australia
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Yang H, Hu B. Application of artificial intelligence to endoscopy on common gastrointestinal benign diseases. Artif Intell Gastrointest Endosc 2021; 2:25-35. [DOI: 10.37126/aige.v2.i2.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/17/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) has been widely involved in every aspect of healthcare in the preclinical stage. In the digestive system, AI has been trained to assist auxiliary examinations including histopathology, endoscopy, ultrasonography, computerized tomography, and magnetic resonance imaging in detection, diagnosis, classification, differentiation, prognosis, and quality control. In the field of endoscopy, the application of AI, such as automatic detection, diagnosis, classification, and invasion depth, in early gastrointestinal (GI) cancers has received wide attention. There is a paucity of studies of AI application on common GI benign diseases based on endoscopy. In the review, we provide an overview of AI applications to endoscopy on common GI benign diseases including in the esophagus, stomach, intestine, and colon. It indicates that AI will gradually become an indispensable part of normal endoscopic detection and diagnosis of common GI benign diseases as clinical data, algorithms, and other related work are constantly repeated and improved.
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Affiliation(s)
- Hang Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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5
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Kew GS, Soh AYS, Lee YY, Gotoda T, Li YQ, Zhang Y, Chan YH, Siah KTH, Tong D, Law SYK, Ruszkiewicz A, Tseng PH, Lee YC, Chang CY, Quach DT, Kusano C, Bhatia S, Wu JCY, Singh R, Sharma P, Ho KY. Multinational survey on the preferred approach to management of Barrett’s esophagus in the Asia-Pacific region. World J Gastrointest Oncol 2021; 13:279-294. [PMID: 33889279 PMCID: PMC8040063 DOI: 10.4251/wjgo.v13.i4.279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/31/2020] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major societies provide differing guidance on management of Barrett’s esophagus (BE), making standardization challenging.
AIM To evaluate the preferred diagnosis and management practices of BE among Asian endoscopists.
METHODS Endoscopists from across Asia were invited to participate in an online questionnaire comprising eleven questions regarding diagnosis, surveillance and management of BE.
RESULTS Five hundred sixty-nine of 1016 (56.0%) respondents completed the survey, with most respondents from Japan (n = 310, 54.5%) and China (n = 129, 22.7%). Overall, the preferred endoscopic landmark of the esophagogastric junction was squamo-columnar junction (42.0%). Distal palisade vessels was preferred in Japan (59.0% vs 10.0%, P < 0.001) while outside Japan, squamo-columnar junction was preferred (59.5% vs 27.4%, P < 0.001). Only 16.3% of respondents used Prague C and M criteria all the time. It was never used by 46.1% of Japanese, whereas 84.2% outside Japan, endoscopists used it to varying extents (P < 0.001). Most Asian endoscopists (70.8%) would survey long-segment BE without dysplasia every two years. Adherence to Seattle protocol was poor with only 6.3% always performing it. 73.2% of Japanese never did it, compared to 19.3% outside Japan (P < 0.001). The most preferred (74.0%) treatment of non-dysplastic BE was proton pump inhibitor only when the patient was symptomatic or had esophagitis. For BE with low-grade dysplasia, 6-monthly surveillance was preferred in 61.9% within Japan vs 47.9% outside Japan (P < 0.001).
CONCLUSION Diagnosis and management of BE varied within Asia, with stark contrast between Japan and outside Japan. Most Asian endoscopists chose squamo-columnar junction to be the landmark for esophagogastric junction, which is incorrect. Most also did not consistently use Prague criteria, and Seattle protocol. Lack of standardization, education and research are possible reasons.
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Affiliation(s)
- Guan Sen Kew
- Department of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
| | - Alex Yu Sen Soh
- Department of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Yan-Qing Li
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yan Zhang
- Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan 250012, Shandong Province, China
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Kewin Tien Ho Siah
- Department of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore 119228, Singapore
| | - Daniel Tong
- Department of Surgery, The University of Hong Kong, Hong Kong Pokfulam, Hong Kong, China
| | - Simon Ying Kit Law
- Department of Surgery, The University of Hong Kong, Hong Kong Pokfulam, Hong Kong, China
| | | | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Vietnam, Hochiminh 70000, Viet Nam
| | - Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai 400012, India
| | - Justin Che-Yuen Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide 64128, Australia
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, KS 64128, United States
| | - Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
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Amano Y, Ishimura N, Ishihara S. Is Malignant Potential of Barrett’s Esophagus Predictable by Endoscopy Findings? Life (Basel) 2020; 10:life10100244. [PMID: 33081277 PMCID: PMC7602941 DOI: 10.3390/life10100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
Given that endoscopic findings can be used to predict the potential of neoplastic progression in Barrett’s esophagus (BE) cases, the detection rate of dysplastic Barrett’s lesions may become higher even in laborious endoscopic surveillance because a special attention is consequently paid. However, endoscopic findings for effective detection of the risk of neoplastic progression to esophageal adenocarcinoma (EAC) have not been confirmed, though some typical appearances are suggestive. In the present review, endoscopic findings that can be used predict malignant potential to EAC in BE cases are discussed. Conventional results obtained with white light endoscopy, such as length of BE, presence of esophagitis, ulceration, hiatal hernia, and nodularity, are used as indicators of a higher risk of neoplastic progression. However, there are controversies in some of those findings. Absence of palisade vessels may be also a new candidate predictor, as that reveals degree of intense inflammation and of cyclooxygenase-2 protein expression with accelerated cellular proliferation. Furthermore, an open type of mucosal pattern and enriched stromal blood vessels, which can be observed by image-enhanced endoscopy, including narrow band imaging, have been confirmed as factors useful for prediction of neoplastic progression of BE because they indicate more frequent cyclooxygenase-2 protein expression along with accelerated cellular proliferation. Should the malignant potential of BE be shown predictable by these endoscopic findings, that would simplify methods used for an effective surveillance, because patients requiring careful monitoring would be more easily identified. Development in the near future of a comprehensive scoring system for BE based on clinical factors, biomarkers and endoscopic predictors is required.
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Affiliation(s)
- Yuji Amano
- Department of Endoscopy, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan
- Correspondence: ; Tel.: +81-047-711-8700; Fax: +81-047-392-8718
| | - Norihisa Ishimura
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan; (N.I.); (S.I.)
| | - Shunji Ishihara
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan; (N.I.); (S.I.)
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The Efficacy of Linked Color Imaging in the Endoscopic Diagnosis of Barrett's Esophagus and Esophageal Adenocarcinoma. Gastroenterol Res Pract 2020; 2020:9604345. [PMID: 33061962 PMCID: PMC7542478 DOI: 10.1155/2020/9604345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background The present study aimed to evaluate the efficacy of linked color imaging (LCI) in diagnosing Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Methods A total of 112 and 12 consecutive patients with BE and EAC were analyzed. The visibility scores of BE and EAC ranging from 4 (excellent visibility) to 0 (not detectable) were evaluated by three trainees and three experts using white light imaging (WLI), LCI mode, and blue laser imaging bright (BLI-b) mode. In addition, L∗a∗b∗ color values and color differences (ΔE∗) were evaluated using the CIELAB color space system. Results The visibility score of the BE in LCI mode (2.94 ± 1.32) was significantly higher than those in WLI (2.46 ± 1.48) and BLI-b mode (2.35 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent gastric mucosa in LCI mode (17.11 ± 8.53) was significantly higher than those in other modes (12.52 ± 9.37 in WLI and 11.96 ± 6.59 in BLI-b mode, p < 0.01). The visibility scores of EAC in LCI mode (2.56 ± 1.47) and BLI-b mode (2.51 ± 1.28) were significantly higher than that in WLI (1.64 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent normal Barrett's mucosa in LCI mode (19.96 ± 7.97) was significantly higher than that in WLI (12.95 ± 11.86) (p = 0.03). Conclusion The present findings suggest that LCI increases the visibility of BE and EAC and contributes to the improvement of the detection of these lesions.
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Quach DT, Pham QT, Tran TL, Vu NT, Le QD, Nguyen DT, Dang NL, Le HM, Le NQ, Sharma P, Ho KY. Prevalence, clinical characteristics, and risk factors of Barrett esophagus in Vietnamese patients with upper gastrointestinal symptoms. Medicine (Baltimore) 2020; 99:e21791. [PMID: 32846811 PMCID: PMC7447484 DOI: 10.1097/md.0000000000021791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The current barrier for investigation of Barrett esophagus (BE) in Asia is diagnostic standardization, which is a challenge to identify its true risk factors. This study aimed to investigate the prevalence, clinical characteristics and risk factors of BE in Vietnamese patients with upper gastrointestinal symptoms.A cross-sectional study was conducted on consecutive outpatients who underwent upper gastrointestinal endoscopy. Endoscopically suspected esophageal metaplasia (ESEM) which was clearly visible at least 1 cm above the gastroesophageal junction at endoscopy was taken biopsy. At least 1 biopsy per 2 cm in tongues of ESEM and 4 biopsies per 2 cm of circumferential ESEM were taken. The diagnostic criterion for BE was replacement of the normal squamous epithelial lining by columnar epithelium confirmed by histology.A total of 1947 patients were recruited. Forty-seven out of 58 patients with ESEM were histologically confirmed BE. The prevalences of BE and hiatal hernia (HH) were 2.4% (95% confidence interval [CI], 1.7-3.1%) and 2.3% (95% CI, 1.6-2.9%), respectively. Heartburn and/or regurgitation presented in only 61.7% (95% CI, 46.4-75.5%) of patients with BE. In multivariate analysis, the only 2 factors significantly associated with BE were HH (OR 7.53; 95% CI, 3.13-18.11; P < .001) and typical reflux symptom (OR 2.07; 95% CI, 1.12-3.83; P = .020).BE is not uncommon in Vietnamese patients with upper gastrointestinal symptoms. In addition, typical reflux symptoms and HH are the risk factors for BE in Vietnamese.
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Affiliation(s)
- Duc T. Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City
- Department of Endoscopy, University Medical Center at Hochiminh City
- Department of Gastroenterology, Gia-Dinh's People Hospital
| | | | - Truc L.T. Tran
- Department of Endoscopy, University Medical Center at Hochiminh City
| | - Nhu T.H. Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City
- Department of Endoscopy, University Medical Center at Hochiminh City
| | - Quang D. Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City
- Department of Endoscopy, University Medical Center at Hochiminh City
- Department of Gastroenterology, Gia-Dinh's People Hospital
| | - Doan T.N. Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City
- Department of Endoscopy, University Medical Center at Hochiminh City
| | - Ngoc L.B. Dang
- Department of Endoscopy, University Medical Center at Hochiminh City
| | - Huy M. Le
- Department of Endoscopy, University Medical Center at Hochiminh City
- Department of Surgical Pathology, University of Medicine and Pharmacy at Hochiminh City, Hochiminh City, Vietnam
| | - Nhan Q. Le
- Department of Endoscopy, University Medical Center at Hochiminh City
| | - Prateek Sharma
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO
| | - Khek-Yu Ho
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
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Podboy A, Kolahi KS, Friedland S, Louie CY. Endoscopic submucosal dissection is associated with less pathologic uncertainty than endoscopic mucosal resection in diagnosing and staging Barrett's-related neoplasia. Dig Endosc 2020; 32:346-354. [PMID: 31306525 DOI: 10.1111/den.13487] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have demonstrated similar efficacy in removal of neoplastic esophageal lesions. However, significant controversy exists over the preferred resection technique. Our primary aim was to compare the pathologic specimens produced via EMR and ESD and secondarily gauge their effect on clinical decision making and patient outcomes. METHODS Using a retrospective cohort study design, all esophageal Barrett's-associated neoplastic lesions resected by a single provider from 2012 to 2017 were reviewed. The pathology was re-reviewed by two blinded authors for diagnosis, margins, and adverse outcomes and recurrence rates were also collected. RESULTS Thirty-one EMR and 20 ESD cases were identified. Baseline demographics and lesion characteristics were similar. ESD produced more R0 resections and more en bloc resections compared to EMR. EMR produced more equivocal lateral (13/31, 41.9% vs 1/20, 5.0%) and vertical margins (13/31, 41.9% vs. 0/20, 0%, both P < 0.05). This led to an inability to reach a definitive diagnosis in 13/31 EMR vs 0/20 ESD pathology specimens (P = 0.003). Of the 13 EMR specimens with equivocal pathology, 11 were noted to have 'at least intramucosal adenocarcinoma'. Four of the 11 patients chose to undergo elective esophagectomy with final surgical pathology demonstrating ≤T1a disease in 2, and ≥T1b disease in two. CONCLUSION Compared to ESD, EMR was associated with greater pathologic uncertainty in Barrett's-associated neoplasia.
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Affiliation(s)
- Alexander Podboy
- Division of Gastroenterology and Hepatology, Stanford University Hospital, Stanford, USA
| | | | - Shai Friedland
- Division of Gastroenterology and Hepatology, Stanford University Hospital, Stanford, USA.,Department of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
| | - Christine Y Louie
- Division of Pathology, Stanford University Hospital, Stanford, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
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