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Beaton DR, Sharp L, Lu L, Trudgill NJ, Thoufeeq M, Nicholson BD, Rogers P, Docherty J, Jenkins A, Morris AJ, Rösch T, Rutter MD. Diagnostic yield from symptomatic gastroscopy in the UK: British Society of Gastroenterology analysis using data from the National Endoscopy Database. Gut 2024:gutjnl-2024-332071. [PMID: 38697772 DOI: 10.1136/gutjnl-2024-332071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This national analysis aimed to calculate the diagnostic yield from gastroscopy for common symptoms, guiding improved resource utilisation. DESIGN A cross-sectional study was conducted of diagnostic gastroscopies between 1 March 2019 and 29 February 2020 using the UK National Endoscopy Database. Mixed-effect logistic regression models were used, incorporating random (endoscopist) and fixed (symptoms, age and sex) effects on two dependent variables (endoscopic cancer; Barrett's oesophagus (BO) diagnosis). Adjusted positive predictive values (aPPVs) were calculated. RESULTS 382 370 diagnostic gastroscopies were analysed; 30.4% were performed in patients aged <50 and 57.7% on female patients. The overall unadjusted PPV for cancer was 1.0% (males 1.7%; females 0.6%, p<0.01). Other major pathology was found in 9.1% of procedures, whereas 89.9% reported only normal findings or minor pathology (92.5% in females; 94.6% in patients <50).Highest cancer aPPVs were reached in the over 50s (1.3%), in those with dysphagia (3.0%) or weight loss plus another symptom (1.4%). Cancer aPPVs for all other symptoms were below 1%, and for those under 50, remained below 1% regardless of symptom. Overall, 73.7% of gastroscopies were carried out in patient groups where aPPV cancer was <1%.The overall unadjusted PPV for BO was 4.1% (males 6.1%; females 2.7%, p<0.01). The aPPV for BO for reflux was 5.8% and ranged from 3.2% to 4.0% for other symptoms. CONCLUSIONS Cancer yield was highest in elderly male patients, and those over 50 with dysphagia. Three-quarters of all gastroscopies were performed on patients whose cancer risk was <1%, suggesting inefficient resource utilisation.
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Affiliation(s)
- David Robert Beaton
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Mo Thoufeeq
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian D Nicholson
- University of Oxford Department of Primary Care Health Sciences, Oxford, UK
| | | | | | | | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf Department of Interdisciplinary Endoscopy, Hamburg, Germany
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
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Black EL, Ococks E, Devonshire G, Ng AWT, O'Donovan M, Malhotra S, Tripathi M, Miremadi A, Freeman A, Coles H, Fitzgerald RC. Understanding the malignant potential of gastric metaplasia of the oesophagus and its relevance to Barrett's oesophagus surveillance: individual-level data analysis. Gut 2024; 73:729-740. [PMID: 37989565 DOI: 10.1136/gutjnl-2023-330721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Whether gastric metaplasia (GM) of the oesophagus should be considered as Barrett's oesophagus (BO) is controversial. Given concern intestinal metaplasia (IM) may be missed due to sampling, the UK guidelines include GM as a type of BO. Here, we investigated whether the risk of misdiagnosis and the malignant potential of GM warrant its place in the UK surveillance. DESIGN We performed a thorough pathology and endoscopy review to follow clinical outcomes in a novel UK cohort of 244 patients, covering 1854 person years of follow-up. We complemented this with a comparative genomic analysis of 160 GM and IM specimens, focused on early molecular hallmarks of BO and oesophageal adenocarcinoma (OAC). RESULTS We found that 58 of 77 short-segment (<3 cm) GM (SS-GM) cases (75%) continued to be observed as GM-only across a median of 4.4 years of follow-up. We observed that disease progression in GM-only cases and GM+IM cases (cases with reported GM on some occasions, IM on others) was significantly lower than in the IM-only cases (Kaplan-Meier, p=0.03). Genomic analysis revealed that the mutation burden in GM is significantly lower than in IM (p<0.01). Moreover, GM does not bear the mutational hallmarks of OAC, with an absence of associated signatures and driver gene mutations. Finally, we established that GM found adjacent to OAC is evolutionarily distant from cancer. CONCLUSION SS-GM is a distinct entity from SS-IM and the malignant potential of GM is lower than IM. It is questionable whether SS-GM warrants inclusion in BO surveillance.
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Affiliation(s)
- Emily L Black
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Emma Ococks
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ginny Devonshire
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Alvin Wei Tian Ng
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Shalini Malhotra
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Monika Tripathi
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ahmad Miremadi
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Adam Freeman
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Hannah Coles
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Rebecca C Fitzgerald
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
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Stachler MD, Ain QU. Refining definitions of Barrett's oesophagus to improve clinical resource utilisation. Gut 2024; 73:715-716. [PMID: 38216329 DOI: 10.1136/gutjnl-2023-331458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Matthew D Stachler
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Qurat Ul Ain
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
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Byrne CJ, Brennan P, Carberry J, Cotton J, Dillon JF. Long-term risk factors for developing Barrett's oesophagus in patients with gastro-oesophageal reflux disease: a longitudinal cohort study. BMJ Open Gastroenterol 2024; 11:e001307. [PMID: 38519048 DOI: 10.1136/bmjgast-2023-001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/25/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND AND AIMS Several characteristics are known to affect the risk of Barrett's oesophagus (BO) in the general population, with symptomatic gastro-oesophageal reflux disease (GORD) being a critical risk factor. In this study, we examined factors that influence BO development in people living with GORD. DESIGN People living with GORD were recruited from an endoscopy unit with lifestyle, medical and prescribing history collected. Logistic regression analysis was undertaken to assess the effects of multiple parameters on the likelihood of developing BO. RESULTS 1197 participants were recruited. Most were Caucasian (n=1188, 99%), had no formal educational qualifications (n=714; 59.6%) and lived with overweight (mean body mass index >25 kg/m2). Many lived in areas of least socioeconomic resource (n=568; 47.4%). 139 (11.6%) had BO at baseline. In adjusted baseline analysis (n=1197), male sex (adjusted OR, aOR 2.04 (95% CI 1.92 to 4.12), p≤0.001), increasing age (aOR 1.03 (95% CI 1.01 to 1.04), p≤0.0001) and proton pump inhibitor use (aOR 3.03 (95% CI 1.80 to 5.13), p≤0.0001) were associated with higher odds of BO. At follow-up (n=363), 22 (6.1%) participants developed BO; male sex (aOR 3.18 (95% CI 1.28 to 7.86), p=0.012), pack-years cigarettes smoked (aOR 1.04 (95% CI 1.00 to 1.08), p=0.046) and increased alcohol intake (aOR 1.02 (95% CI 1.00 to 1.04), p=0.013), were associated with increased odds of BO. CONCLUSION Male sex, pack-years cigarettes smoked, and increasing alcohol intake, were independently associated with increased odds of developing BO over 20-year follow-up. These results align with research linking male sex and smoking with BO and extend this by implicating the potential role of alcohol in developing BO, which may require communication through public health messaging.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Directorate of Public Health, NHS Tayside, Dundee, UK
| | - Paul Brennan
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Dundee, UK
| | - James Carberry
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - James Cotton
- Department of Gastroenterology, NHS Tayside, Dundee, UK
| | - John F Dillon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
- Department of Gastroenterology, NHS Tayside, Dundee, UK
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Liu BD, Song G. Author reply to: Exploring the impact of short-acting GLP-1 receptor agonists on GERD risk. Gut 2024:gutjnl-2024-332058. [PMID: 38383143 DOI: 10.1136/gutjnl-2024-332058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Benjamin Douglas Liu
- Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Massey BT. GORD and GLP-1 receptor agonists: an emerging concern for gastroenterologists. Gut 2024; 73:211-212. [PMID: 37918890 DOI: 10.1136/gutjnl-2023-331027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
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Ratcliffe E, Britton J, Yalamanchili H, Rostami I, Nadir SMH, Korani M, Eruchie I, Wazirdin MA, Prasad N, Hamdy S, McLaughlin J, Ang Y. Dedicated service for Barrett's oesophagus surveillance endoscopy yields higher dysplasia detection and guideline adherence in a non-tertiary setting in the UK: a 5-year comparative cohort study. Frontline Gastroenterol 2024; 15:21-27. [PMID: 38487558 PMCID: PMC10935534 DOI: 10.1136/flgastro-2023-102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Barrett's oesophagus (BO) endoscopic surveillance is performed to varying quality, dedicated services may offer improved outcomes. This study compares a dedicated BO service to standard care, specifically dysplasia detection rate (DDR), guideline adherence and use of advanced imaging modalities in a non-tertiary setting. Design/method 5-year retrospective comparative cohort study comparing a dedicated BO endoscopy service with surveillance performed on non-dedicated slots at a non-tertiary centre in the UK. All adult patients undergoing BO surveillance between 1 March 2016 and 1 March 2021 were reviewed and those who underwent endoscopy on a dedicated BO service run by endoscopists with training in BO was compared with patients receiving their BO surveillance on any other endoscopy list. Endoscopy reports, histology results and clinic letters were reviewed for DDR and British society of gastroenterology guideline adherence. Results 921 BO procedures were included (678 patients). 574 (62%) endoscopies were on a dedicated BO list vs 348 (38%) on non-dedicated.DDR was significantly higher in the dedicated cohort 6.3% (36/568) vs 2.7% (9/337) (p=0.014). Significance was sustained when cases with indefinite for dysplasia were excluded: 4.9% 27/533 vs 0.9% 3/329 (p=0.002). Guideline adherence was significantly better on the dedicated endoscopy lists.Factors associated with dysplasia detection in regression analysis included visible lesion documentation (p=0.036), use of targeted biopsies (p=<0.001), number of biopsies obtained (p≤0.001). Conclusions A dedicated Barrett's service showed higher DDR and guideline adherence than standard care and may be beneficial pending randomised trial data.
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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 Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
| | - James Britton
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - Harika Yalamanchili
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Izabela Rostami
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Mohamed Korani
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ikedichukwu Eruchie
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Neeraj Prasad
- Gastroenterology department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, University of Manchester, Manchester, UK
- Gastroenterology department, Northern Care Alliance NHS Trust, Salford, UK
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8
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Liu BD, Song G. Author reply to: Increased Incidence of GERD in GLP-1 treated patients - fact or artefact? Gut 2023:gutjnl-2023-331411. [PMID: 38050074 DOI: 10.1136/gutjnl-2023-331411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Affiliation(s)
| | - Gengqing Song
- Department of Gastroenterology and Hepatology, Case Western Reserve University, Cleveland, Ohio, USA
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9
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Schröder J, Chegwidden L, Maj C, Gehlen J, Speller J, Böhmer AC, Borisov O, Hess T, Kreuser N, Venerito M, Alakus H, May A, Gerges C, Schmidt T, Thieme R, Heider D, Hillmer AM, Reingruber J, Lyros O, Dietrich A, Hoffmeister A, Mehdorn M, Lordick F, Stocker G, Hohaus M, Reim D, Kandler J, Müller M, Ebigbo A, Fuchs C, Bruns CJ, Hölscher AH, Lang H, Grimminger PP, Dakkak D, Vashist Y, May S, Görg S, Franke A, Ellinghaus D, Galavotti S, Veits L, Weismüller J, Dommermuth J, Benner U, Rösch T, Messmann H, Schumacher B, Neuhaus H, Schmidt C, Wissinowski TT, Nöthen MM, Dong J, Ong JS, Buas MF, Thrift AP, Vaughan TL, Tomlinson I, Whiteman DC, Fitzgerald RC, Jankowski J, Vieth M, Mayr A, Gharahkhani P, MacGregor S, Gockel I, Palles C, Schumacher J. GWAS meta-analysis of 16 790 patients with Barrett's oesophagus and oesophageal adenocarcinoma identifies 16 novel genetic risk loci and provides insights into disease aetiology beyond the single marker level. Gut 2023; 72:612-623. [PMID: 35882562 DOI: 10.1136/gutjnl-2021-326698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/07/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Oesophageal cancer (EC) is the sixth leading cause of cancer-related deaths. Oesophageal adenocarcinoma (EA), with Barrett's oesophagus (BE) as a precursor lesion, is the most prevalent EC subtype in the Western world. This study aims to contribute to better understand the genetic causes of BE/EA by leveraging genome wide association studies (GWAS), genetic correlation analyses and polygenic risk modelling. DESIGN We combined data from previous GWAS with new cohorts, increasing the sample size to 16 790 BE/EA cases and 32 476 controls. We also carried out a transcriptome wide association study (TWAS) using expression data from disease-relevant tissues to identify BE/EA candidate genes. To investigate the relationship with reported BE/EA risk factors, a linkage disequilibrium score regression (LDSR) analysis was performed. BE/EA risk models were developed combining clinical/lifestyle risk factors with polygenic risk scores (PRS) derived from the GWAS meta-analysis. RESULTS The GWAS meta-analysis identified 27 BE and/or EA risk loci, 11 of which were novel. The TWAS identified promising BE/EA candidate genes at seven GWAS loci and at five additional risk loci. The LDSR analysis led to the identification of novel genetic correlations and pointed to differences in BE and EA aetiology. Gastro-oesophageal reflux disease appeared to contribute stronger to the metaplastic BE transformation than to EA development. Finally, combining PRS with BE/EA risk factors improved the performance of the risk models. CONCLUSION Our findings provide further insights into BE/EA aetiology and its relationship to risk factors. The results lay the foundation for future follow-up studies to identify underlying disease mechanisms and improving risk prediction.
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Affiliation(s)
- Julia Schröder
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Laura Chegwidden
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Carlo Maj
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Jan Gehlen
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Jan Speller
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Anne C Böhmer
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Oleg Borisov
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Timo Hess
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Nicole Kreuser
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Andrea May
- Department of Gastroenterology, Oncology and Pneumology, Asklepios Paulinen Clinic Wiesbaden, Wiesbaden, Germany
| | - Christian Gerges
- Department of Internal Medicine II, Evangelisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Rene Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - Axel M Hillmer
- Institute of Pathology, Faculty of Medicine and University Hospital Cologne, University Hospital Cologne, Cologne, Germany
| | - Julian Reingruber
- Center for Human Genetics, University Hospital of Marburg, Marburg, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Arne Dietrich
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Gertraud Stocker
- University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - Michael Hohaus
- Department for General and Visceral Surgery, Städt. Klinikum Dresden Friedrichstadt, Dresden, Germany
| | - Daniel Reim
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, München, Germany
| | - Jennis Kandler
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Dusseldorf, Medical Faculty of Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| | - Michaela Müller
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University, Marburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Arnulf H Hölscher
- Department for General, Visceral and Trauma Surgery, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Dani Dakkak
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | | | - Sandra May
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Siegfried Görg
- Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck/Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sara Galavotti
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lothar Veits
- Institute of Pathology, Friedrich-Alexander-Universiät Erlangen-Nürnberg, Klinikum Bayreuth, Bayreuth, Germany
| | | | | | - Udo Benner
- Gastroenterologische Gemeinschaftspraxis, Koblenz, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Brigitte Schumacher
- Department of Internal Medicine and Gastroenterology, Elisabeth Hospital Essen, Essen, Germany
| | - Horst Neuhaus
- Department of Internal Medicine II, Evangelisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Carsten Schmidt
- Medical Clinic II (Gastroenterology, Hepatology, Endocrinology, Diabetology and Infektiology), Klinikum Fulda, University Medicine Marburg-Campus Fulda, Fulda, Germany
- Medical Faculty, Friedrich Schiller University Jena, Jena, Germany
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Jing Dong
- Division of Hematology and Oncology, Department of Medicine, Cancer Center, and Genomic Sciences & Precision Medicine Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jue-Sheng Ong
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Matthew F Buas
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas L Vaughan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ian Tomlinson
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh, UK
| | - David C Whiteman
- Cancer Control, Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Rebecca Claire Fitzgerald
- Medical Research Council (MRC) Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Janusz Jankowski
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-Universiät Erlangen-Nürnberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Andreas Mayr
- Institute of Medical Biometrics, Informatics and Epidemiology (IMBIE), Medical Faculty, University of Bonn, Bonn, Germany
| | - Puya Gharahkhani
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Claire Palles
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Genta RM. Gastro-oesophageal junction: a conceptual agreement at last? Frontline Gastroenterol 2022; 14:271-272. [PMID: 37409337 DOI: 10.1136/flgastro-2022-102310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Robert M Genta
- Pathology, Baylor College of Medicine, Houston, Texas, USA
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12
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Neilson LJ, Fitzgerald RC, Deane J, Debiram-Beecham I, Sharp L, Rees CJ. Measuring patient experience of Cytosponge using the Newcastle ENDOPREM. Frontline Gastroenterol 2022; 14:355-356. [PMID: 37409338 DOI: 10.1136/flgastro-2022-102288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 08/31/2023] Open
Affiliation(s)
- Laura Jane Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca C Fitzgerald
- Early Cancer Institute, University of Cambridge, Cambridge, UK
- Early Detection Programme, CRUK Cambridge Centre, Cambridge, UK
| | - Jennifer Deane
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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13
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Sugano K, Spechler SJ, El-Omar EM, McColl KEL, Takubo K, Gotoda T, Fujishiro M, Iijima K, Inoue H, Kawai T, Kinoshita Y, Miwa H, Mukaisho KI, Murakami K, Seto Y, Tajiri H, Bhatia S, Choi MG, Fitzgerald RC, Fock KM, Goh KL, Ho KY, Mahachai V, O'Donovan M, Odze R, Peek R, Rugge M, Sharma P, Sollano JD, Vieth M, Wu J, Wu MS, Zou D, Kaminishi M, Malfertheiner P. Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction. Gut 2022; 71:1488-1514. [PMID: 35725291 PMCID: PMC9279854 DOI: 10.1136/gutjnl-2022-327281] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ. DESIGN Clinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement. Two rounds of voting and amendments were completed before the meeting at which clinical questions and consensus were finalised. RESULTS Twenty eight clinical questions and statements were finalised after extensive amendments. Critical consensus was achieved: (1) definition for the GOJ, (2) definition of the GOJZ spanning 1 cm proximal and distal to the GOJ as defined by the end of palisade vessels was accepted based on the anatomical distribution of cardiac type gland, (3) chemical and bacterial (Helicobacter pylori) factors as the primary causes of inflammation, metaplasia and neoplasia occurring in the GOJZ, (4) a new definition of Barrett's oesophagus (BO). CONCLUSIONS This international consensus on the new definitions of BO, GOJ and the GOJZ will be instrumental in future studies aiming to resolve many issues on this important anatomic area and hopefully will lead to better classification and management of the diseases surrounding the GOJ.
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Affiliation(s)
- Kentaro Sugano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Stuart Jon Spechler
- Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas, USA
| | - Emad M El-Omar
- Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine & Health, Sydney, New South Wales, Australia
| | - Kenneth E L McColl
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kaiyo Takubo
- Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | | | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Kobe, Japan
| | - Ken-ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Yuhu, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisao Tajiri
- Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | | | - Myung-Gyu Choi
- Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Rebecca C Fitzgerald
- Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, UK
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Duke NUS School of Medicine, National University of Singapore, Singapore
| | | | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Varocha Mahachai
- Center of Excellence in Digestive Diseases, Thammasat University and Science Resarch and Innovation, Bangkok, Thailand
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospital NHS Trust UK, Cambridge, UK
| | - Robert Odze
- Department of Pathology, Tuft University School of Medicine, Boston, Massachusetts, USA
| | - Richard Peek
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Massimo Rugge
- Department of Medicine DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Friedrich-Alexander University Erlangen, Nurenberg, Germany
| | - Justin Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Duowu Zou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Peter Malfertheiner
- Medizinixhe Klinik und Poliklinik II, Ludwig Maximillian University Klinikum, Munich, Germany,Klinik und Poliklinik für Radiologie, Ludwig Maximillian University Klinikum, Munich, Germany
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14
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Lim S, Haboubi HN, Anderson SHC, Dawson P, Machado AP, Mangsat E, Santos S, Wong T, Zeki S, Dunn J. Transnasal endoscopy: moving from endoscopy to the clinical outpatient-blue sky thinking in oesophageal testing. Frontline Gastroenterol 2022; 13:e65-e71. [PMID: 35812036 PMCID: PMC9234731 DOI: 10.1136/flgastro-2022-102129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gastrointestinal endoscopy given its limited use of space, no sedation and reduced nursing resources. OUR EXPERIENCE We describe piloting and then establishing an outpatient model TNE service in the pandemic era and the implications on resource allocation, training and workforce. We also discuss our experiences and outline ways in which services can evolve to undertake more complex endoscopic diagnostic and therapeutic work. Over 90% of patients describe no discomfort and those who have previously experienced conventional transoral endoscopy preferred the transnasal approach. We describe a low complication rate (0.8%) comprising two episodes of mild epistaxis. The average procedure duration was reasonable (9.9±5.0 min) with full adherence to Joint Advisory Group quality standards. All biopsies assessed were deemed sufficient for diagnosis including those for surveillance procedures. DISCUSSION TNE can offer a safe, tolerable, high-quality service outside of a conventional endoscopy setting. Expanding procedural capacity without impacting on the current endoscopy footprint has great potential in recovering endoscopy services following the COVID-19 pandemic. Looking forward, TNE has potential to be used both within the endoscopy suite as part of therapeutic procedures, or outside of the endoscopy unit in outpatient clinics, community hospitals, or mobile units and to achieve this in a more sustainable and environmentally friendly way.
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Affiliation(s)
- Samuel Lim
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hasan Nadim Haboubi
- Gastroenterology, University Hospital Llandough, Cardiff, UK,Institute of Life Sciences, Swansea University, Swansea, UK
| | - Simon H C Anderson
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Dawson
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Paula Machado
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edna Mangsat
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sara Santos
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Terry Wong
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastian Zeki
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Comprehensive Cancer Centre, King's College London, London, UK
| | - Jason Dunn
- Gastroenterology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Comprehensive Cancer Centre, King's College London, London, UK
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15
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di Pietro M, Fitzgerald RC. Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett's oesophagus with low-grade dysplasia. Gut 2018; 67:392-393. [PMID: 28389530 PMCID: PMC5868287 DOI: 10.1136/gutjnl-2017-314135] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/17/2017] [Accepted: 03/19/2017] [Indexed: 12/12/2022]
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16
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Buas MF, He Q, Johnson LG, Onstad L, Levine DM, Thrift AP, Gharahkhani P, Palles C, Lagergren J, Fitzgerald RC, Ye W, Caldas C, Bird NC, Shaheen NJ, Bernstein L, Gammon MD, Wu AH, Hardie LJ, Pharoah PD, Liu G, Iyer P, Corley DA, Risch HA, Chow WH, Prenen H, Chegwidden L, Love S, Attwood S, Moayyedi P, MacDonald D, Harrison R, Watson P, Barr H, deCaestecker J, Tomlinson I, Jankowski J, Whiteman DC, MacGregor S, Vaughan TL, Madeleine MM. Germline variation in inflammation-related pathways and risk of Barrett's oesophagus and oesophageal adenocarcinoma. Gut 2017; 66:1739-1747. [PMID: 27486097 PMCID: PMC5296402 DOI: 10.1136/gutjnl-2016-311622] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/22/2016] [Accepted: 07/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oesophageal adenocarcinoma (OA) incidence has risen sharply in Western countries over recent decades. Local and systemic inflammation is considered an important contributor to OA pathogenesis. Established risk factors for OA and its precursor, Barrett's oesophagus (BE), include symptomatic reflux, obesity and smoking. The role of inherited genetic susceptibility remains an area of active investigation. Here, we explore whether germline variation related to inflammatory processes influences susceptibility to BE/OA. DESIGN We used data from a genomewide association study of 2515 OA cases, 3295 BE cases and 3207 controls. Our analysis included 7863 single-nucleotide polymorphisms (SNPs) in 449 genes assigned to five pathways: cyclooxygenase (COX), cytokine signalling, oxidative stress, human leucocyte antigen and nuclear factor-κB. A principal components-based analytic framework was employed to evaluate pathway-level and gene-level associations with disease risk. RESULTS We identified a significant signal for the COX pathway in relation to BE risk (p=0.0059, false discovery rate q=0.03), and in gene-level analyses found an association with microsomal glutathione-S-transferase 1 (MGST1); (p=0.0005, q=0.005). Assessment of 36 MGST1 SNPs identified 14 variants associated with elevated BE risk (q<0.05). Four of these were subsequently confirmed (p<5.5×10-5) in a meta-analysis encompassing an independent set of 1851 BE cases and 3496 controls, and are known strong expression quantitative trait loci for MGST1. Three such variants were associated with similar elevations in OA risk. CONCLUSIONS This study provides the most comprehensive evaluation of inflammation-related germline variation in relation to risk of BE/OA and suggests that variants in MGST1 influence disease susceptibility.
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Affiliation(s)
- Matthew F. Buas
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Qianchuan He
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lisa G. Johnson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Lynn Onstad
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - David M. Levine
- Department of Biostatistics, University of Washington, School of Public Health, Seattle, Washington, USA
| | - Aaron P. Thrift
- Department of Medicine and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Puya Gharahkhani
- Queensland Institute of Medical Research Berghofer Medical Research Institute Brisbane, Queensland, Australia
| | - Claire Palles
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Division of Cancer Studies, King’s College London, United Kingdom
| | - Rebecca C. Fitzgerald
- Medical Research Council (MRC) MRC Cancer Unit, Hutchison-MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carlos Caldas
- Cancer Research UK, Cambridge Institute, Cambridge, UK
| | - Nigel C. Bird
- Department of Oncology, Medical School, University of Sheffield, Sheffield, UK
| | - Nicholas J. Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute and City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Marilie D. Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill,North Carolina, USA
| | - Anna H. Wu
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California, USA
| | | | - Paul D. Pharoah
- Department of Oncology, University of Cambridge, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoffrey Liu
- Pharmacogenomic Epidemiology, Ontario Cancer Institute, Toronto, Ontario, Canada M5G 2M9
| | - Prassad Iyer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Harvey A. Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Wong-Ho Chow
- Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Hans Prenen
- Department of Digestive Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Laura Chegwidden
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK
| | - Sharon Love
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit, Oxford, UK
| | - Stephen Attwood
- Department of General Surgery, North Tyneside General Hospital, North Shields, UK
| | - Paul Moayyedi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David MacDonald
- Department of Oral Biological and Medical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca Harrison
- Department of Pathology, Leicester Royal Infirmary, Leicester, UK
| | - Peter Watson
- Department of Medicine, Institute of Clinical Science, Royal Victoria Hospital, Belfast, UK
| | - Hugh Barr
- Department of Upper GI Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - John deCaestecker
- Department of Gastroenterology, Leicester General Hospital, Leicester, UK
| | - Ian Tomlinson
- Wellcome Trust Centre for Human Genetics and NIHR Comprehensive Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Janusz Jankowski
- University Hospitals Coventry and Warwickshire and University of Warwick, Coventry, UK
| | - David C. Whiteman
- Cancer Control, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Stuart MacGregor
- Queensland Institute of Medical Research Berghofer Medical Research Institute Brisbane, Queensland, Australia
| | - Thomas L. Vaughan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, School of Public Health, Seattle, Washington, USA
| | - Margaret M. Madeleine
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, School of Public Health, Seattle, Washington, USA
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18
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Sanagapalli S, Sweis R. Combined pH-impedance testing for reflux: current state of play and future challenges. Frontline Gastroenterol 2017; 8:154-155. [PMID: 28840917 PMCID: PMC5558282 DOI: 10.1136/flgastro-2017-100840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/02/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Santosh Sanagapalli
- Department of Gastroenterology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - Rami Sweis
- GI Physiology Unit, University College London Hospital, London, UK
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19
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Lipman G, Haidry RJ. Endoscopic management of Barrett's and early oesophageal neoplasia. Frontline Gastroenterol 2017; 8:138-142. [PMID: 28839898 PMCID: PMC5369449 DOI: 10.1136/flgastro-2016-100763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/19/2016] [Accepted: 12/26/2016] [Indexed: 02/04/2023] Open
Abstract
Barrett's oesophagus (BO) is the only known precursor to oesophageal adenocarcinoma (OAC). Dysplasia and intramucosal cancer arising in BO can safely be treated with endoscopic eradication therapy (EET) due to the low risk of subsequent lymph node metastasis. Treatment at an early stage is paramount due to the ongoing poor prognosis and outcomes of patients with advanced OAC. The mainstay of treatment is endoscopic resection of visible lesions for accurate staging followed by ablation therapy to all remaining columnar-lined epithelium, most commonly with radiofrequency ablation. Successful eradication of dysplasia can be achieved in >95% of patients with this EET combined approach.
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Affiliation(s)
- G Lipman
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
| | - RJ Haidry
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
- Division of Surgery & Interventional Science, University College London, London, UK
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20
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The 2017 Dr Falk Pharma UK/Core Awards are open for applications. Frontline Gastroenterol 2017; 8:152. [PMID: 28839901 DOI: 10.1136/flgastro-2016-100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 02/04/2023] Open
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Abstract
The landscape for patients with Barrett's oesophagus (BE) has changed significantly in the last decade. Research and new guidelines have helped gastroenterologists to better identify those patients with BE who are particularly at risk of developing oesophageal adenocarcinoma. In parallel, developments in endoscopic image enhancement technology and optical biopsy techniques have improved our ability to detect high-risk lesions. Once these lesions have been identified, the improvements in minimally invasive endoscopic therapies has meant that these patients can potentially be cured of early cancer and high-risk dysplastic lesions without the need for surgery, which still has a significant morbidity and mortality. The importance of reaching an accurate diagnosis of BE remains of paramount importance. More work is needed, however. The vast majority of those undergoing surveillance for their BE do not progress towards cancer and thus undergo a regular invasive procedure, which may impact on their psychological and physical well-being while incurring significant cost to the health service. New work that explores cheaper endoscopic or non-invasive ways to identify the at-risk individual provides exciting avenues for research. In future, the diagnosis and monitoring of patients with BE could move away from hospitals and into primary care.
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Affiliation(s)
- David Graham
- Division of Surgery and Interventional Science, University College London, London, UK,Gastrointestinal Unit, University College Hospital, London, UK
| | - Gideon Lipman
- Division of Surgery and Interventional Science, University College London, London, UK,Gastrointestinal Unit, University College Hospital, London, UK
| | - Vinay Sehgal
- Division of Surgery and Interventional Science, University College London, London, UK,Gastrointestinal Unit, University College Hospital, London, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London, UK,Gastrointestinal Unit, University College Hospital, London, UK
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Parker C, Alexandridis E, Plevris J, O'Hara J, Panter S. Transnasal endoscopy: no gagging no panic! Frontline Gastroenterol 2016; 7:246-256. [PMID: 28839865 PMCID: PMC5369487 DOI: 10.1136/flgastro-2015-100589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/01/2015] [Accepted: 06/10/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Transnasal endoscopy (TNE) is performed with an ultrathin scope via the nasal passages and is increasingly used. This review covers the technical characteristics, tolerability, safety and acceptability of TNE and also diagnostic accuracy, use as a screening tool and therapeutic applications. It includes practical advice from an ear, nose, throat (ENT) specialist to optimise TNE practice, identify ENT pathology and manage complications. METHODS A Medline search was performed using the terms "transnasal", "ultrathin", "small calibre", "endoscopy", "EGD" to identify relevant literature. RESULTS There is increasing evidence that TNE is better tolerated than standard endoscopy as measured using visual analogue scales, and the main area of discomfort is nasal during insertion of the TN endoscope, which seems remediable with adequate topical anaesthesia. The diagnostic yield has been found to be similar for detection of Barrett's oesophagus, gastric cancer and GORD-associated diseases. There are some potential issues regarding the accuracy of TNE in detecting small early gastric malignant lesions, especially those in the proximal stomach. TNE is feasible and safe in a primary care population and is ideal for screening for upper gastrointestinal pathology. It has an advantage as a diagnostic tool in the elderly and those with multiple comorbidities due to fewer adverse effects on the cardiovascular system. It has significant advantages for therapeutic procedures, especially negotiating upper oesophageal strictures and insertion of nasoenteric feeding tubes. CONCLUSIONS TNE is well tolerated and a valuable diagnostic tool. Further evidence is required to establish its accuracy for the diagnosis of early and small gastric malignancies. There is an emerging role for TNE in therapeutic endoscopy, which needs further study.
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Affiliation(s)
- Clare Parker
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | | | - John Plevris
- Centre for Liver and Digestive Disorders, The Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - James O'Hara
- Department of Otolaryngology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Panter
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, Newcastle upon Tyne, UK
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Timmer MR, Martinez P, Lau CT, Westra WM, Calpe S, Rygiel AM, Rosmolen WD, Meijer SL, ten Kate FJ, Dijkgraaf MG, Mallant-Hent RC, Naber AH, van Oijen AH, Baak LC, Scholten P, Böhmer CJ, Fockens P, Maley CC, Graham TA, Bergman JJ, Krishnadath KK. Derivation of genetic biomarkers for cancer risk stratification in Barrett's oesophagus: a prospective cohort study. Gut 2016; 65:1602-10. [PMID: 26104750 PMCID: PMC4988941 DOI: 10.1136/gutjnl-2015-309642] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/06/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The risk of developing adenocarcinoma in non-dysplastic Barrett's oesophagus is low and difficult to predict. Accurate tools for risk stratification are needed to increase the efficiency of surveillance. We aimed to develop a prediction model for progression using clinical variables and genetic markers. METHODS In a prospective cohort of patients with non-dysplastic Barrett's oesophagus, we evaluated six molecular markers: p16, p53, Her-2/neu, 20q, MYC and aneusomy by DNA fluorescence in situ hybridisation on brush cytology specimens. Primary study outcomes were the development of high-grade dysplasia or oesophageal adenocarcinoma. The most predictive clinical variables and markers were determined using Cox proportional-hazards models, receiver operating characteristic curves and a leave-one-out analysis. RESULTS A total of 428 patients participated (345 men; median age 60 years) with a cumulative follow-up of 2019 patient-years (median 45 months per patient). Of these patients, 22 progressed; nine developed high-grade dysplasia and 13 oesophageal adenocarcinoma. The clinical variables, age and circumferential Barrett's length, and the markers, p16 loss, MYC gain and aneusomy, were significantly associated with progression on univariate analysis. We defined an 'Abnormal Marker Count' that counted abnormalities in p16, MYC and aneusomy, which significantly improved risk prediction beyond using just age and Barrett's length. In multivariate analysis, these three factors identified a high-risk group with an 8.7-fold (95% CI 2.6 to 29.8) increased HR when compared with the low-risk group, with an area under the curve of 0.76 (95% CI 0.66 to 0.86). CONCLUSIONS A prediction model based on age, Barrett's length and the markers p16, MYC and aneusomy determines progression risk in non-dysplastic Barrett's oesophagus.
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Affiliation(s)
- Margriet R. Timmer
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Pierre Martinez
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, EC1M 6BQ, United Kingdom
| | - Chiu T. Lau
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Wytske M. Westra
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Silvia Calpe
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Agnieszka M. Rygiel
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Wilda D. Rosmolen
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Sybren L. Meijer
- Department of Pathology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Fiebo J.W. ten Kate
- Department of Pathology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Marcel G.W. Dijkgraaf
- Clinical Research Unit, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | | | - Anton H.J. Naber
- Department of Gastroenterology, Tergooiziekenhuizen, 1213 XZ, Hilversum, The Netherlands
| | | | - Lubbertus C. Baak
- Department of Gastroenterology, Onze Lieve Vrouwe Gasthuis, 1091 AC, Amsterdam, The Netherlands
| | - Pieter Scholten
- Department of Gastroenterology, Sint Lucas Andreas Ziekenhuis, 1061 AE, Amsterdam, The Netherlands
| | - Clarisse J.M. Böhmer
- Department of Gastroenterology, Spaarne Ziekenhuis, 2134 TM, Hoofddorp, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Carlo C. Maley
- Centre for Evolution and Cancer, University of California at San Francisco, CA 94143-0128, USA
| | - Trevor A. Graham
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, EC1M 6BQ, United Kingdom
| | - Jacques J.G.H.M. Bergman
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
| | - Kausilia K. Krishnadath
- Department of Gastroenterology and Hepatology, Academic Medical Centre – University of Amsterdam, 1011 AZ, Amsterdam, The Netherlands
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Fock KM, Talley N, Goh KL, Sugano K, Katelaris P, Holtmann G, Pandolfino JE, Sharma P, Ang TL, Hongo M, Wu J, Chen M, Choi MG, Law NM, Sheu BS, Zhang J, Ho KY, Sollano J, Rani AA, Kositchaiwat C, Bhatia S. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus. Gut 2016; 65:1402-15. [PMID: 27261337 DOI: 10.1136/gutjnl-2016-311715] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus. METHODS A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations. RESULTS A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer. CONCLUSIONS These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.
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Affiliation(s)
- Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Nicholas Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Khean Lee Goh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kentaro Sugano
- Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Peter Katelaris
- Gastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Holtmann
- Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - John E Pandolfino
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Prateek Sharma
- University of Kansas and VA Medical Center, Kansas City, Kansas, USA
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Michio Hongo
- Department of Comprehensive Medicine, Tohoku University, Sendai, Japan
| | - Justin Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
| | - Minhu Chen
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Myung-Gyu Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ngai Moh Law
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Bor-Shyang Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Jun Zhang
- The Second Affiliated Hospital, Xian Jiaotong University, Xian, China
| | - Khek Yu Ho
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
| | - Jose Sollano
- Department of Medicine, University of Sano Tomas, Manila, Philippines
| | - Abdul Aziz Rani
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Chomsri Kositchaiwat
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shobna Bhatia
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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25
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Hendy P. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett's oesophagus and confirmed low-grade dysplasia. Frontline Gastroenterol 2016; 7:156-157. [PMID: 28839852 PMCID: PMC5369484 DOI: 10.1136/flgastro-2015-100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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26
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Beg S, Wilson A, Ragunath K. The use of optical imaging techniques in the gastrointestinal tract. Frontline Gastroenterol 2016; 7:207-215. [PMID: 27429735 PMCID: PMC4941161 DOI: 10.1136/flgastro-2015-100563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 02/04/2023] Open
Abstract
With significant advances in the management of gastrointestinal disease there has been a move from diagnosing advanced pathology, to detecting early lesions that are potentially amenable to curative endoscopic treatment. This has required an improvement in diagnostics, with a focus on identifying and characterising subtle mucosal changes. There is great interest in the use of optical technologies to predict histology and enable the formulation of a real-time in vivo diagnosis, a so-called 'optical biopsy'. The aim of this review is to explore the evidence for the use of the current commercially available imaging techniques in the gastrointestinal tract.
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Affiliation(s)
- Sabina Beg
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Queens Medical Centre Campus, Nottingham, UK
| | - Ana Wilson
- Department of Gastroenterology, Wolfson Unit for Endoscopy, St Mark's hospital, London, UK
| | - Krish Ragunath
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Queens Medical Centre Campus, Nottingham, UK
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27
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Lavery DL, Martinez P, Gay LJ, Cereser B, Novelli MR, Rodriguez-Justo M, Meijer SL, Graham TA, McDonald SAC, Wright NA, Jansen M. Evolution of oesophageal adenocarcinoma from metaplastic columnar epithelium without goblet cells in Barrett's oesophagus. Gut 2016; 65:907-13. [PMID: 26701877 PMCID: PMC4893117 DOI: 10.1136/gutjnl-2015-310748] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/10/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Barrett's oesophagus commonly presents as a patchwork of columnar metaplasia with and without goblet cells in the distal oesophagus. The presence of metaplastic columnar epithelium with goblet cells on oesophageal biopsy is a marker of cancer progression risk, but it is unclear whether clonal expansion and progression in Barrett's oesophagus is exclusive to columnar epithelium with goblet cells. DESIGN We developed a novel method to trace the clonal ancestry of an oesophageal adenocarcinoma across an entire Barrett's segment. Clonal expansions in Barrett's mucosa were identified using cytochrome c oxidase enzyme histochemistry. Somatic mutations were identified through mitochondrial DNA sequencing and single gland whole exome sequencing. RESULTS By tracing the clonal origin of an oesophageal adenocarcinoma across an entire Barrett's segment through a combination of histopathological spatial mapping and clonal ordering, we find that this cancer developed from a premalignant clonal expansion in non-dysplastic ('cardia-type') columnar metaplasia without goblet cells. CONCLUSION Our data demonstrate the premalignant potential of metaplastic columnar epithelium without goblet cells in the context of Barrett's oesophagus.
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Affiliation(s)
| | - Pierre Martinez
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Laura J Gay
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Marco R Novelli
- Department of Pathology, University College London, London, UK
| | | | - Sybren L Meijer
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Trevor A Graham
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | | | - Marnix Jansen
- Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands
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28
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Kastelein F, van Olphen SH, Steyerberg EW, Spaander MCW, Bruno MJ. Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression. Gut 2016; 65:548-54. [PMID: 25903690 DOI: 10.1136/gutjnl-2014-308802] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/01/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Endoscopic surveillance for Barrett's oesophagus (BO) is under discussion given the overall low incidence of neoplastic progression and lack of evidence that it prevents advanced oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the impact of endoscopic BO surveillance on tumour stage and survival of patients with neoplastic progression. DESIGN 783 patients with BO of at least 2 cm were included in a multicentre prospective cohort and followed during surveillance according to the American College of Gastroenterology guidelines. Cases of high-grade dysplasia and OAC were identified during follow-up. OAC staging was performed according to the 7th UICC-AJCC classification. Survival data were collected and crosschecked using death and municipal registries. Data from patients with OAC in the general population were obtained from the Dutch cancer registry. We compared survival of patients with BO with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population. RESULTS 53 patients with BO developed high-grade dysplasia or OAC during surveillance. Thirty-five (66%) were classified as stage 0, 14 (26%) as stage 1 and 4 (8%) as stage 2. OAC was diagnosed at an earlier stage during BO surveillance than in the general population (p<0.001). Survival of patients with BO with neoplastic progression was not significantly worse than those of patients without neoplastic progression and similar to survival of patients with stage 0 or stage 1 OAC in the general population. CONCLUSIONS OAC is detected at an earlier stage during BO surveillance than in the general population with good survival rates.
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Affiliation(s)
- F Kastelein
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S H van Olphen
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Pohl H, Pech O, Arash H, Stolte M, Manner H, May A, Kraywinkel K, Sonnenberg A, Ell C. Length of Barrett's oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut 2016; 65:196-201. [PMID: 26113177 DOI: 10.1136/gutjnl-2015-309220] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/30/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although it is well understood that the risk of oesophageal adenocarcinoma increases with Barrett length, transition risks for cancer associated with different Barrett lengths are unknown. We aimed to estimate annual cancer transition rates for patients with long-segment (≥3 cm), short-segment (≥1 to <3 cm) and ultra-short-segment (<1 cm) Barrett's oesophagus. DESIGN We used three data sources to estimate the annual cancer transition rates for each Barrett length category: (1) the distribution of long, short and ultra-short Barrett's oesophagus among a large German cohort with newly diagnosed T1 oesophageal adenocarcinoma; (2) population-based German incidence of oesophageal adenocarcinoma; and (3) published estimates of the population prevalence of Barrett's oesophagus for each Barrett length category. RESULTS Among 1017 patients with newly diagnosed T1 oesophageal adenocarcinoma, 573 (56%) had long-segment, 240 (24%) short-segment and 204 (20%) ultra-short-segment Barrett's oesophagus. The base-case estimates for the prevalence of Barrett's oesophagus among the general population were 1.5%, 5% and 14%, respectively. The annual cancer transition rates for patients with long, short and ultra-short Barrett's oesophagus were 0.22%, 0.03% and 0.01%, respectively. To detect one cancer, 450 patients with long-segment Barrett's oesophagus would need to undergo annual surveillance endoscopy; in short segment and ultra-short segment, the corresponding numbers of patients would be 3440 and 12,364. Similar results were obtained when applying US incidence data. CONCLUSIONS The large number of patients, who need to undergo endoscopic surveillance to detect one cancer, raises questions about the value of surveillance endoscopy in patients with short segment or ultra-short segment of Barrett's oesophagus.
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Affiliation(s)
- Heiko Pohl
- Department of Gastroenterology, VA Medical Center, White River Junction, Vermont, USA Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder, Regensburg, Germany
| | - Haris Arash
- Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany
| | - Manfred Stolte
- Department of Pathology, Klinikum Kulmbach, Kulmbach, Germany
| | - Hendrik Manner
- Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany
| | - Andrea May
- Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany Department of Gastroenterology, Sana-Klinikum Offenbach, Offenbach, Germany
| | - Klaus Kraywinkel
- Centre for Cancer Registry Data, Robert Koch-Institute, Berlin, Germany
| | - Amnon Sonnenberg
- Department of Gastroenterology, VA Medical Center, Portland, Oregon, USA
| | - Christian Ell
- Department of Internal Medicine 2, HSK Wiesbaden, Wiesbaden, Germany Department of Gastroenterology, Sana-Klinikum Offenbach, Offenbach, Germany
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Affiliation(s)
- Pieter J F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frederik Hvid-Jensen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark
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Moyes LH, Oien KA, Foulis AK, Fullarton GM, Going JJ. Prevalent low-grade dysplasia: the strongest predictor of malignant progression in Barrett's columnar-lined oesophagus. Gut 2016; 65:360-1. [PMID: 26085438 PMCID: PMC4752652 DOI: 10.1136/gutjnl-2015-309978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/01/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Lisa H Moyes
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Karin A Oien
- Department of Pathology, South Glasgow University Hospital, Glasgow, UK,Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alan K Foulis
- Department of Pathology, South Glasgow University Hospital, Glasgow, UK
| | | | - James J Going
- Department of Pathology, South Glasgow University Hospital, Glasgow, UK,Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Moawad FJ, Young PE, Gaddam S, Vennalaganti P, Thota PN, Vargo J, Cash BD, Falk GW, Sampliner RE, Lieberman D, Sharma P. Barrett's oesophagus length is established at the time of initial endoscopy and does not change over time: results from a large multicentre cohort. Gut 2015; 64:1874-80. [PMID: 25652086 DOI: 10.1136/gutjnl-2014-308552] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/11/2015] [Indexed: 12/08/2022]
Abstract
OBJECTIVE It is unclear whether Barrett's oesophagus (BO) length changes over time or whether the full length of the segment is established at the onset of disease recognition. The objectives of this study were to evaluate the association of age and BO length and to evaluate the changes in BO length over time. DESIGN This is a prospective, multicentre cohort study involving patients with BO from five centres. Patients were divided into groups based on the decade of initial diagnosis of BO. The mean BO length and the mean change in BO length were calculated for each age decade. The mean change in BO length was also calculated between the index endoscopy and the last surveillance endoscopy. RESULTS 3635 patients with BO were included in the study: 87.8% men, 92.8% Caucasians, mean age 60.9 years and mean BO length 3.5 cm. The mean change in BO length was 0.9 cm. The mean BO length did not significantly change for each age category: <30 years (4.6 cm), 30-39.9 years (3.2 cm), 40-49.9 years (3.1 cm), 50-59.9 years (3.1 cm), 60-69.9 years (3.6 cm), 70-79.7 (4.0 cm) and >80 years (4.5 cm), p=0.47. On subgroup analysis of patients with non-dysplastic BO who had at least 1 year of endoscopic follow up, there was a significant decrease in mean change in BO length across age categories ranging from +1.7 to -0.8 cm, p=0.03. CONCLUSIONS There was no significant difference in BO length by age category in decades. In addition, the change in BO length from index to follow-up endoscopy was similar among patients >30 years. These findings suggest that a patient's BO segment length attains its full extent by the time of the initial endoscopic examination.
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Affiliation(s)
- Fouad J Moawad
- Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Patrick E Young
- Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Srinivas Gaddam
- Gastroenterology Division, Washington University in St Louis, St Louis, Missouri, USA
| | - Prashanth Vennalaganti
- Division of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brooks D Cash
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Gary W Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard E Sampliner
- Division of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Prateek Sharma
- Division of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Abstract
The rapid rise in incidence of oesophageal adenocarcinoma has motivated the need for improved methods for surveillance of Barrett's oesophagus. Early neoplasia is flat in morphology and patchy in distribution and is difficult to detect with conventional white light endoscopy (WLE). Light offers numerous advantages for rapidly visualising the oesophagus, and advanced optical methods are being developed for wide-field and cross-sectional imaging to guide tissue biopsy and stage early neoplasia, respectively. We review key features of these promising methods and address their potential to improve detection of Barrett's neoplasia. The clinical performance of key advanced imaging technologies is reviewed, including (1) wide-field methods, such as high-definition WLE, chromoendoscopy, narrow-band imaging, autofluorescence and trimodal imaging and (2) cross-sectional techniques, such as optical coherence tomography, optical frequency domain imaging and confocal laser endomicroscopy. Some of these instruments are being adapted for molecular imaging to detect specific biological targets that are overexpressed in Barrett's neoplasia. Gene expression profiles are being used to identify early targets that appear before morphological changes can be visualised with white light. These targets are detected in vivo using exogenous probes, such as lectins, peptides, antibodies, affibodies and activatable enzymes that are labelled with fluorescence dyes to produce high contrast images. This emerging approach has potential to provide a 'red flag' to identify regions of premalignant mucosa, outline disease margins and guide therapy based on the underlying molecular mechanisms of cancer progression.
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Affiliation(s)
- Matthew B Sturm
- Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Thomas D Wang
- Division of Gastroenterology Departments of Medicine, Biomedical Engineering, Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Departments of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA,Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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35
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Haidry RJ, Butt MA, Dunn JM, Gupta A, Lipman G, Smart HL, Bhandari P, Smith L, Willert R, Fullarton G, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Kapoor N, Hoare J, Narayanasamy R, Ang Y, Veitch A, Ragunath K, Novelli M, Lovat LB. Improvement over time in outcomes for patients undergoing endoscopic therapy for Barrett's oesophagus-related neoplasia: 6-year experience from the first 500 patients treated in the UK patient registry. Gut 2015; 64:1192-9. [PMID: 25539672 PMCID: PMC4515987 DOI: 10.1136/gutjnl-2014-308501] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/29/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Barrett's oesophagus (BE) is a pre-malignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BE-related neoplasia. METHODS We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3-monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated. RESULTS 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51). CONCLUSIONS Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients. TRIAL REGISTRATION NUMBER ISRCTN93069556.
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Affiliation(s)
- R J Haidry
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - M A Butt
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - J M Dunn
- Guy's and St Thomas’ NHS foundation Trust, London, UK,Institute for Cancer Genetics and Informatics, Oslo University, Oslo, Norway
| | - A Gupta
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - G Lipman
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK
| | - H L Smart
- Department of Gastroenterology and Hepatology, Royal Liverpool University Hospital, Liverpool, UK
| | - P Bhandari
- Princess Alexandra Hospital, Portsmouth, UK
| | - L Smith
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - R Willert
- Central Manchester University Hospitals NHS Foundation Trust, Manchester,UK
| | | | | | - C Gordon
- Royal Bournemouth Hospital, Bournemouth, UK
| | - I Penman
- Royal Infirmary Edinburgh, Edinburgh, UK
| | - H Barr
- Oesophagogastric Surgery, Gloucestershire Hospital NHS Trust, Birmingham, UK
| | - P Patel
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - N Kapoor
- Digestive Diseases Centre, Aintree University Hospital, Liverpool, UK
| | - J Hoare
- St Mary's Hospital NHS Trust, London, UK
| | | | - Y Ang
- Centre of Gastrointestinal Sciences, University of Manchester, Salford Royal Foundation NHS Trust, Salford, UK
| | - A Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - K Ragunath
- Department of Gastroenterology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - M Novelli
- Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - L B Lovat
- Research Department of Tissue and Energy, Division of Surgery and Interventional Science, University College London, London, UK,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
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36
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Tham TCK, Gleeson D, Greenfield SM, Harris A, Cort S. British Society of Gastroenterology policy and processes for the development of guidelines. Gut 2015; 64:1184-5. [PMID: 25666194 DOI: 10.1136/gutjnl-2015-309164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 01/21/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Tony C K Tham
- Clinical Services and Standards Committee, British Society of Gastroenterology, London, UK
| | - Dermot Gleeson
- Clinical Services and Standards Committee, British Society of Gastroenterology, London, UK
| | - Simon M Greenfield
- Clinical Services and Standards Committee, British Society of Gastroenterology, London, UK
| | - Adam Harris
- Clinical Services and Standards Committee, British Society of Gastroenterology, London, UK
| | - Simone Cort
- Clinical Services and Standards Committee, British Society of Gastroenterology, London, UK
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37
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Kastelein F, van Olphen S, Steyerberg EW, Sikkema M, Spaander MCW, Looman CWN, Kuipers EJ, Siersema PD, Bruno MJ, de Bekker-Grob EW. Surveillance in patients with long-segment Barrett's oesophagus: a cost-effectiveness analysis. Gut 2015; 64:864-71. [PMID: 25037191 DOI: 10.1136/gutjnl-2014-307197] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 07/04/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Surveillance is recommended for Barrett's oesophagus (BO) to detect early oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the cost-effectiveness of surveillance. DESIGN We included 714 patients with long-segment BO in a multicentre prospective cohort study and used a multistate Markov model to calculate progression rates from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD) and OAC. Progression rates were incorporated in a decision-analytic model, including costs and quality of life data. We evaluated different surveillance intervals for ND and LGD, endoscopic mucosal resection (EMR), radiofrequency ablation (RFA) and oesophagectomy for HGD or early OAC and oesophagectomy for advanced OAC. The incremental cost-effectiveness ratio (ICER) was calculated in costs per quality-adjusted life-year (QALY). RESULTS The annual progression rate was 2% for ND to LGD, 4% for LGD to HGD or early OAC and 25% for HGD or early OAC to advanced OAC. Surveillance every 5 or 4 years with RFA for HGD or early OAC and oesophagectomy for advanced OAC had ICERs of €5.283 and €62.619 per QALY for ND. Surveillance every five to one year had ICERs of €4.922, €30.067, €32.531, €41.499 and €75.601 per QALY for LGD. EMR prior to RFA was slightly more expensive, but important for tumour staging. CONCLUSIONS Based on a Dutch healthcare perspective and assuming a willingness-to-pay threshold of €35.000 per QALY, surveillance with EMR and RFA for HGD or early OAC, and oesophagectomy for advanced OAC is cost-effective every 5 years for ND and every 3 years for LGD.
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Affiliation(s)
- F Kastelein
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S van Olphen
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Sikkema
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C W Spaander
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C W N Looman
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P D Siersema
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J Bruno
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E W de Bekker-Grob
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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39
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Abstract
Endoscopic surveillance remains the core management of non-dysplastic Barrett's oesophagus, although questions regarding its efficacy in reducing mortality from oesophageal adenocarcinoma have yet to be definitively answered, and randomised trial data are awaited. One of the main goals of current research is to achieve risk stratification, identifying those at high risk of progression. The recent British Society of Gastroenterology (BSG) guidelines on surveillance have taken a step in this direction with interval stratification on clinicopathological grounds. The majority of Barrett's oesophagus remains undiagnosed, and this has led to investigation of methods of screening for Barrett's oesophagus, ideally non-endoscopic methods capable of reliably identifying dysplasia. Chemoprevention to prevent progression is currently under investigation, and may become a key component of future treatment. The availability of effective endotherapy means that accurate identification of dysplasia is more important than ever. There is now evidence to support intervention with radiofrequency ablation (RFA) for low-grade dysplasia (LGD), but recent data have emphasised the need for consensus pathology for LGD. Ablative treatment has become well established for high-grade dysplasia, and should be employed for flat lesions where there is no visible abnormality. Of the ablative modalities, RFA has the strongest evidence base. Endoscopic resection should be performed for all visible lesions, and is now the treatment of choice for T1a tumours. Targeting those with high-risk disease will, hopefully, lead to efficacious and cost-effective surveillance, and the trend towards earlier intervention to halt progression gives cause for optimism that this will ultimately result in fewer deaths from oesophageal adenocarcinoma.
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Affiliation(s)
- O J Old
- Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK,Upper GI Surgery Department, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK
| | - L M Almond
- Upper GI Surgery Department, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - H Barr
- Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK,Upper GI Surgery Department, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Trust, Gloucester, UK
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40
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Bhat SK, McManus DT, Coleman HG, Johnston BT, Cardwell CR, McMenamin U, Bannon F, Hicks B, Kennedy G, Gavin AT, Murray LJ. Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study. Gut 2015; 64:20-5. [PMID: 24700439 DOI: 10.1136/gutjnl-2013-305506] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Endoscopic surveillance of Barrett's oesophagus (BO) provides an opportunity to detect early stage oesophageal adenocarcinoma (OAC). We sought to determine the proportion of OAC patients with a prior diagnosis of BO on a population basis and to evaluate the influence of a prior diagnosis of BO on survival, taking into account lead and length time biases. DESIGN A retrospective population-based study of all OAC patients in Northern Ireland between 2003 and 2008. A prior BO diagnosis was determined by linkage to the Northern Ireland BO register. Stage distribution at diagnosis and histological grade were compared between patients with and without a prior BO diagnosis. Overall survival, using Cox models, was compared between patients with and without a prior BO diagnosis. The effect of adjusting the survival differences for histological grade and estimates of lead and length time bias was assessed. RESULTS There were 716 OAC cases, 52 (7.3%) of whom had a prior BO diagnosis. Patients with a prior BO diagnosis had significantly lower tumour stage (44.2% vs. 11.1% had stage 1 or 2 disease; p<0.001), a higher rate of surgical resection (50.0% vs. 25.5%; p<0.001) and had a higher proportion of low/intermediate grade tumours (46.2% vs. 26.5%; p=0.011). A prior BO diagnosis was associated with significantly better survival (HR for death 0.39; 95% CI 0.27 to 0.58), which was minimally influenced by adjustment for age, sex and tumour grade (adjusted HR 0.44; 95% CI 0.30 to 0.64). Correction for lead time bias attenuated but did not abolish the survival benefit (HR 0.65; 95% CI 0.45 to 0.95) and further adjustment for length time bias had little effect. CONCLUSIONS The proportion of OAC patients with a prior diagnosis of BO is low; however, prior identification of BO is associated with an improvement in survival in OAC patients.
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Affiliation(s)
- Shivaram K Bhat
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Damian T McManus
- Department of Pathology, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Helen G Coleman
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Brian T Johnston
- Department of Gastroenterology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Christopher R Cardwell
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Una McMenamin
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Finian Bannon
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, Northern Ireland
| | - Blanaid Hicks
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Grace Kennedy
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, Northern Ireland
| | - Liam J Murray
- Centre for Public Health, Institute of Clinical Sciences - Block B, Queens University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
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Barbera M, di Pietro M, Walker E, Brierley C, MacRae S, Simons BD, Jones PH, Stingl J, Fitzgerald RC. The human squamous oesophagus has widespread capacity for clonal expansion from cells at diverse stages of differentiation. Gut 2015; 64:11-9. [PMID: 24572143 PMCID: PMC4283695 DOI: 10.1136/gutjnl-2013-306171] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/06/2014] [Accepted: 01/30/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Knowledge of the cellular mechanisms involved in homeostasis of human squamous oesophagus in the steady state and following chronic injury is limited. We aimed to better understand these mechanisms by using a functional 3D approach. DESIGN Proliferation, mitosis and the expression of progenitor lineage markers were assessed in normal squamous oesophagus from 10 patients by immunofluorescence on 3D epithelial whole mounts. Cells expressing differential levels of epithelial and progenitor markers were isolated using flow cytometry sorting and characterised by qPCR and IF. Their self-renewing potential was investigated by colony forming cells assays and in vitro organotypic culture models. RESULTS Proliferation and mitotic activity was highest in the interpapillary basal layer and decreased linearly towards the tip of the papilla (p<0.0001). The orientation of mitosis was random throughout the basal layer, and asymmetric divisions were not restricted to specific cell compartments. Cells sorted into distinct populations based on the expression of epithelial and progenitor cell markers (CD34 and EpCAM) showed no difference in self-renewal in 2D culture, either as whole populations or as single cells. In 3D organotypic cultures, all cell subtypes were able to recapitulate the architecture of the tissue of origin and the main factor determining the success of the 3D culture was the number of cells plated, rather than the cell type. CONCLUSIONS Oesophageal epithelial cells demonstrate remarkable plasticity for self-renewal. This situation could be viewed as an ex vivo wounding response and is compatible with recent findings in murine models.
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Affiliation(s)
| | | | - Elaine Walker
- MRC Cancer Unit, University of Cambridge Cambridge, UK
| | | | - Shona MacRae
- MRC Cancer Unit, University of Cambridge Cambridge, UK
| | - Benjamin D Simons
- Cavendish Laboratory, Department of Physics, J. J. Thomson Avenue University of Cambridge, Cambridge, UK
- The Wellcome Trust/Cancer Research UK Gurdon Institute, University of Cambridge, Cambridge, UK
- Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Phil H Jones
- MRC Cancer Unit, University of Cambridge Cambridge, UK
| | - John Stingl
- University of Cambridge, CRUK—Cambridge Institute, Cambridge, UK
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Attwood S. New Barrett's guidelines: an opportunity to improve patient experience and save resources. Frontline Gastroenterol 2015; 6:4-5. [PMID: 28840918 PMCID: PMC5369610 DOI: 10.1136/flgastro-2014-100486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 02/04/2023] Open
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Abstract
Although endoscopic surveillance of patients with Barrett's oesophagus has been widely implemented, its effectiveness is debateable. The recently reported low annual oesophageal adenocarcinoma risk in population studies, the failure to identify most Barrett's patients at risk of disease progression, the poor adherence to surveillance and biopsy protocols, and the significant risk of misclassification of dysplasia all tend to undermine the effectiveness of current management, in particular, endoscopic surveillance programmes, to prevent or improve the outcomes of patients with oesophageal adenocarcinoma. The ongoing increase in incidence of Barrett's oesophagus and consequent growth of the surveillance population, together with the associated discomfort and costs of endoscopic surveillance, demand improved techniques for accurately determining individual risk of oesophageal adenocarcinoma. More accurate techniques are needed to run efficient surveillance programmes in the coming decades. In this review, we will discuss the current knowledge on the epidemiology of Barrett's oesophagus, and the challenging epidemiological dilemmas that need to be addressed when assessing the current screening and surveillance strategies.
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Affiliation(s)
- Pieter Jan F de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, , Rotterdam, The Netherlands
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45
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Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O'Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014; 63:7-42. [PMID: 24165758 DOI: 10.1136/gutjnl-2013-305372] [Citation(s) in RCA: 809] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.
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