scholarly journals A Survey of Canadian Gastroenterologists about the Management of Barrett’s Esophagus

2003 ◽  
Vol 17 (5) ◽  
pp. 313-317 ◽  
Author(s):  
Lisa MacNeil-Covin ◽  
Alan G Casson ◽  
Dickran Malatjalian ◽  
Sander Veldhuyzen van Zanten
Keyword(s):  
Gastroesophageal Reflux ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Overall Response Rate ◽  
Practice Patterns ◽  
Low Grade ◽  
Canadian Association ◽  
Four Quadrant ◽  
Current Guidelines ◽  
Structured Questionnaire

The aims of the present study were to determine practice patterns of Canadian gastroenterologists for screening patients with Barrett’s esophagus and to compare current practice patterns with published guidelines. A secondary goal was to evaluate whether gastroenterologists recommend a ’once in a lifetime’ endoscopy for patients with chronic gastroesophageal reflux disease. A structured questionnaire regarding screening for Barrett’s esophagus was sent to members of the Canadian Association of Gastroenterology. The overall response rate was 51% (203 of 396). Of the 203 respondents, 165 (81%) performed endoscopies in adults and form the basis of this report. The majority of Canadian gastroenterologists followed published guidelines, with 62% screening patients without dysplasia every two years. Patients with low grade dysplasia were screened more frequently, with 54% of respondents performing endoscopy every six months, and 35% on a yearly basis. Biopsy protocols showed the greatest variation, with 46% of gastroenterologists taking four-quadrant biopsies at 2 cm intervals along the columnar-lined (Barrett’s) esophagus. Seventy-six per cent of gastroenterologists agreed that all patients with chronic gastroesophageal reflux should have a ’once in a lifetime’ endoscopy to screen for Barrett’s esophagus. The majority of Canadian gastroenterologists follow current guidelines for the management of Barrett’s esophagus and support the concept of ’once in a lifetime’ endoscopy.

scholarly journals RADIOFREQUENCY ABLATION IN TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE WITH BARRETT’S ESOPHAGUS

2019 ◽  
Vol 21 (1) ◽  
pp. 117-122
Author(s):  
K V Puchkov ◽  
E V Khabarova ◽  
E S Tishchenko
Keyword(s):  
Radiofrequency Ablation ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Barrett’S Esophagus ◽  
Reflux Disease ◽  
Barrett's Esophagus ◽  
Antireflux Surgery ◽  
Low Grade ◽  
Results Of Treatment

OBJECTIVE: To evaluate results of treatment of patients with Barrett’s esophagus, including radiofrequency ablation of columnar epithelium with antireflux surgery. METHODS: We treated82 patients with gastroesophageal reflux disease withBarrett’s esophagus between 2011 and 2018. 4 patients had low-grade dysplasia, 63 patients had hiatal hernia. We performed laparoscopic Toupet 2700 fundoplication in 58 of these patients.This allowedto perform radiofrequency ablation (RFA) procedure 2-3 months later in 27 of these patients. In 12 patients without radiological signs of hiatal hernia we performed RFA as the first treatment step. Follow-up endoscopy was performed 3,6 and 12 months after RFA. RESULTS: Metaplasia eradication wasachieved in 97,5% after 1 procedure and in 100% after 2 procedures. 6 months after treatment recurrence of metaplasia was registered in 2,4% patients. CONCLUSIONS: Changing security profile of new endoscopic treatment methods indicates the need for new strategies for Barrett’s esophagus. The most effective scheme is two-step treatment including antireflux surgery and radiofrequency ablation in combination with drug therapy.

scholarly journals Adherence to quality indicators and surveillance guidelines in the management of Barrett’s esophagus: a retrospective analysis

2018 ◽  
Vol 06 (03) ◽  
pp. E300-E307 ◽  
Author(s):  
Donevan Westerveld ◽  
Vikas Khullar ◽  
Lazarus Mramba ◽  
Fares Ayoub ◽  
Tony Brar ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Quality Indicators ◽  
Barrett's Esophagus ◽  
Practice Patterns ◽  
Multiple Logistic Regression Analysis ◽  
Cost Effective ◽  
Therapeutic Interventions ◽  
Patient Demographics ◽  
Effective Care ◽  
Four Quadrant

Abstract Background Adherence to quality indicators and surveillance guidelines in the management of Barrett’s esophagus (BE) promotes high-quality, cost-effective care. The aims of this study were (1) to evaluate adherence to standardized classification (Prague Criteria) and systematic (four-quadrant) biopsy protocol, (2) to identify predictors of practice patterns, and (3) to assess adherence to surveillance guidelines for non-dysplastic BE (NDBE). Methods This was a single-center retrospective study of esophagogastroduodenoscopy (EGD) performed for BE (June 2008 to December 2015). Patient demographics, procedure characteristics, and histology results were obtained from the procedure report-generating database and chart review. Adherence to Prague Criteria and systematic biopsies was based on operative report documentation. Multiple logistic regression analysis was performed to identify predictors of practice patterns. Guideline adherent surveillance EGD was defined as those performed within 6 months of the recommended 3- to 5-year interval. Results In total, 397 patients (66.5 % male; mean age 60.1 ± 12.5 years) had an index EGD during the study period. Adherence to Prague Criteria and systematic biopsies was 27.4 % and 24.1 %, respectively. Endoscopists who performed therapeutic interventions for BE were more likely to use the Prague Criteria (OR: 3.16; 95 %CI: 1.47 – 6.82; P < 0.01) than those who did not. Longer time in practice was positively associated with adherence to Prague Criteria (OR 1.07; 95 %CI: 1.02 – 1.12; P < 0.01) but with a lower likelihood of performing systematic biopsies (OR 0.91; 95 %CI: 0.85 – 0.97; P < 0.01). More than half (55.6 %) of patients with NDBE underwent surveillance EGD sooner (range 1 – 29 months) than the recommended interval. Conclusion Adherence to quality indicators and surveillance guidelines in BE is low. Operator characteristics, including experience with endoscopic therapy for BE and time in practice predicted practice pattern. Future efforts are needed to reduce variability in practice and promote high-value care.

Barrett's esophagus in women, a manifestation of severe gastroesophageal reflux disease

2001 ◽  
Vol 120 (5) ◽  
pp. A410-A410
Author(s):  
F BANKI ◽  
S DEMEESTER ◽  
R MASON ◽  
G CAMPOS ◽  
C STREETS ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Barrett’S Esophagus ◽  
Reflux Disease ◽  
Barrett's Esophagus

scholarly journals TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

2021 ◽  
Vol 09 (03) ◽  
pp. E348-E355
Author(s):  
David L. Diehl ◽  
Harshit S. Khara ◽  
Nasir Akhtar ◽  
Rebecca J. Critchley-Thorne
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Clinical Decision Making ◽  
Eradication Therapy ◽  
Low Risk ◽  
Management Approach ◽  
Low Grade ◽  
Management Decisions ◽  
The Impact

Abstract Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

Endoscopic Expert Revision of Previous Histological Confirmed Flat Low-Grade Dysplasia In Barrett’s Esophagus

2021 ◽  
Author(s):  
EA Nieuwenhuis ◽  
SN van Munster ◽  
BLAM Weusten ◽  
L Alvarez Herrero ◽  
A Bogte ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Low Grade ◽  
Low Grade Dysplasia

scholarly journals Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry

Endoscopy ◽  
2018 ◽  
Vol 51 (04) ◽  
pp. 317-325 ◽  
Author(s):  
Joke Vliebergh ◽  
Pierre Deprez ◽  
Danny de Looze ◽  
Marc Ferrante ◽  
Hans Orlent ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Complete Remission ◽  
Barrett’S Esophagus ◽  
Endoscopic Resection ◽  
Barrett's Esophagus ◽  
Recurrent Disease ◽  
Low Grade ◽  
Sustained Remission ◽  
Efficacy And Safety ◽  
Efficient Treatment

Abstract Background Radiofrequency ablation (RFA), combined with endoscopic resection, can be used as a primary treatment for low grade dysplasia, high grade dysplasia, and early esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE). The aim of the Belgian RFA registry is to capture the real-life outcome of endoscopic therapy for BE with RFA and to assess efficacy and safety outside study protocols, in the absence of reimbursement. Patients and methods Between February 2008 and January 2017, data from 7 different expert centers were prospectively collected in the registry. Efficacy outcomes included complete remission of intestinal metaplasia (CR-IM), complete remission of dysplasia (CR-D), and durability of remission. Safety outcomes included immediate and late adverse events. Results 684 RFA procedures in 342 different patients were registered. Of these, 295 patients were included in the efficacy analysis, with CR-IM achieved in 88 % and CR-D in 93 %, in per-protocol analysis; corresponding rates in intention-to-treat analysis were 82 % and 87 %, respectively. Sustained remission was seen in 65 % with a median (interquartile range) follow-up of 25 (12 – 47) months. No risk factors for recurrent disease were identified. Immediate complications occurred in 4 % of all procedures and 6 % of all patients, whereas late complications occurred in 9 % of all procedures and in 20 % of all patients. Conclusions Data from the Belgian registry confirm that RFA in combination with endoscopic resection is an efficient treatment for BE with dysplasia or early EAC. In the absence of reimbursement, more rescue treatments are used, not compromising outcome. Since there is recurrent disease after CR-IM in 35 %, surveillance endoscopy remains necessary.

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