Original articleClinical endoscopyDetection and staging of esophageal cancers within Barrett's esophagus is improved by assessment in specialized Barrett's units
Section snippets
Aims
In a cohort of patients with dysplastic BE identified in the community setting, we aimed to determine the additional detection rate of mucosal abnormalities and EACs identified in a BE unit. We aimed to compare endoscopy methods used in the community versus those used in a BE unit to see which factors contributed to overall lesion and cancer detection rates. We also aimed to assess the impact of EMR on histopathological staging and subsequent patient management.
Referrals
Consecutive patients referred to St. Vincent's Hospital Melbourne from November 2008 to September 2011 for management of dysplastic BE were prospectively entered into a central database. Patient demographic characteristics and the most advanced histology at and before referral and referral endoscopy details were recorded. These details, where provided, included BE extent, NBI use, presence and size of a hiatal hernia, and description of any mucosal abnormality.
Assessment
Systematic assessment by using
Patient details and histology at referral
Sixty-nine patients (61 male) were included in this study. Demographic and clinical details and the most advanced pathology at referral are summarized in Table 1.
The cases of 65 of 69 patients were reviewed by our GI pathologist (R.W.), with 4 unavailable for review. Fifty-five reviews resulted in agreement with the original histological grade. In 7 cases, there was downgrading (1 low-grade dysplasia [LGD] to IM, 6 HGD to LGD), and in 3 cases, there was upgrading (3 HGD to IMC). As such, the
Discussion
This is a large single-center experience of assessment and management of patients with dysplastic BE. Three important conclusions can be inferred from our results. The first is that systematic assessment of BE segments by experienced endoscopists with access to HD-WLE and NBI results in increased detection rates of mucosal abnormalities. Second, this increased detection correlates with an increased cancer detection rate. Finally, EMR of mucosal lesions harboring cancer is critical in staging
Conclusion
Assessment of patients with dysplastic BE at a BE unit resulted in improved detection of mucosal abnormalities and EAC. EMR of these early cancers was a critical step in determining a patient's appropriateness for endoscopic therapy. We currently recommend that referral to a BE unit be considered in all patients with dysplastic BE to optimize detection of the most advanced histopathology and to perform EMR for staging of early cancers where necessary before embarking on a definitive management
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2020, GastroenterologyCitation Excerpt :The rates of progression from flat HGD to EAC are approximately 5%–8% per year. Truly flat HGD is uncommon and the majority of HGD patients will have a visible lesion seen on HD-WLE.9 The presence of ulcerated lesions within HGD should raise suspicion for invasive cancer, and curative BET is probably not feasible.
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.