Advertisement

Diagnosis and Management of Barrett’s Esophagus

  • Kathryn R. Byrne
  • Douglas G. AdlerEmail author
Chapter
  • 710 Downloads

Abstract

There has been an increase in the incidence of esophageal adenocarcinoma in the USA since the 1970s. The goal of screening and surveillance endoscopy for Barrett’s esophagus was to identify and then subsequently treat the patients who are at the highest risk for the development of esophageal adenocarcinoma. In general, the American GI societies, including the American Gastroenterological Society (AGA), American College of Gastroenterology (ACG), and American Society for Gastrointestinal Endoscopy (ASGE), are in agreement with screening guidelines for Barrett’s esophagus. Screening should be considered for patients at higher risk for the development of esophageal cancer, and endoscopic screening has not been advocated for the general population. Non-dysplastic Barrett’s esophagus is most often followed with surveillance endoscopy and biopsies every 3–5 years. Since non-dysplastic Barrett’s esophagus has a low risk of progression to esophageal adenocarcinoma, endoscopic treatment is not generally recommended. Endoscopic treatment with ablative therapy, mechanical therapy, or combination of both is recommended for patients with Barrett’s esophagus with confirmed low-grade dysplasia, high-grade dysplasia, and intramucosal carcinoma. After complete eradication of both intestinal metaplasia and dysplasia, patients should continue to have endoscopic surveillance to monitor for recurrence of disease.

Keywords

Barrett’s esophagus Dysplasia Radiofrequency ablation Cryotherapy HALO Esophageal cancer 

Supplementary material

Video 5.1

Endoscopic ablation of Barrett’s Esophagus (MP4 202137 kb)

References

  1. 1.
    American Gastroenterological Association, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140(3):1084.Google Scholar
  2. 2.
    Shaheen NJ, Weinberg DS, Denberg TD, Chou R, Qaseem A, Shekelle P. Clinical guidelines committee of the American College of Physicians. Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians. Ann Intern Med. 2012;157(11):808.CrossRefPubMedGoogle Scholar
  3. 3.
    Rubenstein JH, Taylor JB. Meta-analysis: the association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther. 2010;32(10):1222.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lagergren J, Bergström R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340(11):825.CrossRefPubMedGoogle Scholar
  5. 5.
    Nicholas J, Shaheen, Falk GW, Iyer PG, Gerson L. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol Adv. online publication, 3 November 2015.Google Scholar
  6. 6.
    Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, Jankowski JA, Junghard O, Lundell L, Tytgat GN, Vieth M. The development and validation of an endoscopic grading system for Barrett’s esophagus: the prague C&M criteria. Gastroenterology. 2006;131(5):1392.CrossRefPubMedGoogle Scholar
  7. 7.
    ASGE Standards of Practice Committee, Evans JA, Early DS, Fukami N, Ben-Menachem T, Chandrasekhara V, Chathadi KV, Decker GA, Fanelli RD, Fisher DA, Foley KQ, Hwang JH, Jain R, Jue TL, Khan KM, Lightdale J, Malpas PM, Maple JT, Pasha SF, Saltzman JR, Sharaf RN, Shergill A, Dominitz JA, Cash BD. Standards of practice Committee of the American Society for gastrointestinal endoscopy. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc. 2012;76(6):1087–94.Google Scholar
  8. 8.
    Levine DS, Haggitt RC, Blount PL, Rabinovitch PS, Rusch VW, Reid BJ. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus. Gastroenterology. 1993;105(1):40–50.CrossRefPubMedGoogle Scholar
  9. 9.
    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(1):7–42 Epub 2013 Oct 28.CrossRefPubMedGoogle Scholar
  10. 10.
    Bennett C, Moayyedi P, Corley DA, DeCaestecker J, Falck-Ytter Y, Falk G, Vakil N, Sanders S, Vieth M, Inadomi J, Aldulaimi D, Ho KY, Odze R, Meltzer SJ, Quigley E, Gittens S, Watson P, Zaninotto G, Iyer PG, Alexandre L, Ang Y, Callaghan J, Harrison R, Singh R, Bhandari P, Bisschops R, Geramizadeh B, Kaye P, Krishnadath S, Fennerty MB, Manner H, Nason KS, Pech O, Konda V, Ragunath K, Rahman I, Romero Y, Sampliner R, Siersema PD, Tack J, Tham TC, Trudgill N, Weinberg DS, Wang J, Wang K, Wong JY, Attwood S, Malfertheiner P, MacDonald D, Barr H, Ferguson MK, Jankowski J. BOB CAT consortium. BOB CAT: a large-scale review and Delphi consensus for management of Barrett’s Esophagus with no Dysplasia, indefinite for, or low-grade Dysplasia. Am J Gastroenterol. 2015;110(5):662.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Tomizawa Y, Iyer PG, Wong Kee Song LM, et al. Safety of endoscopic mucosal resection for Barrett’s esophagus. Am J Gastroenterol. 2013;108:1440–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Konda VJ, Gonzalez Haba Ruiz M, Koons A, et al. Complete endoscopic mucosal resection is effective and durable treatment for Barretts-associated neoplasia. Clin Gastroenterol Hepatol. 2014;12:2002–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N. Endoscopic mucosal resection. Gastrointest Endosc. 2003;57(4):567.CrossRefPubMedGoogle Scholar
  15. 15.
    Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66:100–7.CrossRefPubMedGoogle Scholar
  16. 16.
    van Vilsteren FG, Pouw RE, Seewald S, et al. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut. 2011;60:765–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Seewald S, Akaraviputh T, Seitz U, et al. Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma. Gastrointest Endosc. 2003;57:854–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Peters FP, Kara MA, Rosmolen WD, et al. Stepwise radical endoscopic resection is effective for complete removal of Barrett’s esophagus with early neoplasia: a prospective study. Am J Gastroenterol. 2006;101:1449–57.CrossRefPubMedGoogle Scholar
  19. 19.
    Qumseya B, Panossian AM, Rizk C, et al. Predictors of esophageal stricture formation post endoscopic mucosal resection. Clin Endosc. 2014;47:155–61.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Katada C, Muto M, Manabe T, Boku N, Ohtsu A, Yoshida S. Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc. 2003;57(2):165.CrossRefPubMedGoogle Scholar
  21. 21.
    Qumseya B, Panossian AM, Rizk C, Cangemi D, Wolfsen C, Raimondo M, Woodward T, Wallace MB, Wolfsen H. Predictors of esophageal stricture formation post endoscopic mucosal resection. Clin Endosc. 2014;47(2):155–61.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Konda VJ, Gonzalez Haba Ruiz M, Koons A, Hart J, Xiao SY, Siddiqui UD, Ferguson MK, Posner M, Patti MG, Waxman I. Complete endoscopic mucosal resection is effective and durable treatment for Barrett’s-associated neoplasia. Clin Gastroenterol Hepatol. 2014;12(12):2002-10.e1–2.CrossRefGoogle Scholar
  23. 23.
    Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD study group multicenter study. Gastrointest Endosc. 2009;69(7):1228–35.CrossRefPubMedGoogle Scholar
  24. 24.
    Isomoto H, Yamaguchi N, Minami H, Nakao K. Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc. 2013;25(Suppl 1):29–38.CrossRefPubMedGoogle Scholar
  25. 25.
    van Lanschot JJ, Hulscher JB, Buskens CJ, Tilanus HW, ten Kate FJ, Obertop H. Hospital volume and hospital mortality for esophagectomy. Cancer. 2001;91(8):1574.CrossRefPubMedGoogle Scholar
  26. 26.
    Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, Kagaya H, Shimizu Y, Hokari K, Tsukagoshi H, Shinomura Y, Fujita M. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72(2):255–64 264.e1-2.CrossRefPubMedGoogle Scholar
  27. 27.
    Mizuta H, Nishimori I, Kuratani Y, Higashidani Y, Kohsaki T, Onishi S. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22(7):626–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009;41(8):661–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Kim JS, Kim BW, Shin IS. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci. 2014;59(8):1862–9.CrossRefPubMedGoogle Scholar
  30. 30.
    van Vilsteren FG, Phoa KN, Alvarez Herrero L, Pouw RE, Sondermeijer CM, van Lijnschoten I, Seldenrijk KA, Visser M, Meijer SL, van Berge Henegouwen MI, Weusten BL, Schoon EJ, Bergman JJ. Circumferential balloon-based radiofrequency ablation of Barrett’s esophagus with dysplasia can be simplified, yet efficacy maintained, by omitting the cleaning phase. Clin Gastroenterol Hepatol. 2013;11(5):491.e1–498.e1.Google Scholar
  31. 31.
    Akiyama J, Marcus SN, Triadafilopoulos G. Effective intra-esophageal acid control is associated with improved radiofrequency ablation outcomes in Barrett’s esophagus. Dig Dis Sci. 2012;57(10):2625.CrossRefPubMedGoogle Scholar
  32. 32.
    Lyday WD, Corbett FS, Kuperman DA, Kalvaria I, Mavrelis PG, Shughoury AB, Pruitt RE. Radiofrequency ablation of Barrett’s esophagus: outcomes of 429 patients from a multicenter community practice registry. Endoscopy. 2010;42(4):272.CrossRefPubMedGoogle Scholar
  33. 33.
    Orman ES, Li N, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s esophagus: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2013;11(10):1245.CrossRefPubMedGoogle Scholar
  34. 34.
    Greenwald BD, Dumot JA, Abrams JA, Lightdale CJ, David DS, Nishioka NS, Yachimski P, Johnston MH, Shaheen NJ, Zfass AM, Smith JO, Gill KR, Burdick JS, Mallat D, Wolfsen HC. Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy. Gastrointest Endosc. 2010;71(4):686–93.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gosain S, Mercer K, Twaddell WS, Uradomo L, Greenwald BD. Liquid nitrogen spray cryotherapy in Barrett’s esophagus with high-grade dysplasia: long-term results. Gastrointest Endosc. 2013;78(2):260.CrossRefPubMedGoogle Scholar
  36. 36.
    Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, Jobe BA, Eisen GM, Fennerty MB, Hunter JG, Fleischer DE, Sharma VK, Hawes RH, Hoffman BJ, Rothstein RI, Gordon SR, Mashimo H, Chang KJ, Muthusamy VR, Edmundowicz SA, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Falk GW, Kimmey MB, Madanick RD, Chak A, Lightdale CJ. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360(22):2277.CrossRefPubMedGoogle Scholar
  37. 37.
    Chadwick G, Groene O, Markar SR, Hoare J, Cromwell D, Hanna GB. Systematic review comparing radiofrequency ablation and complete endoscopic resection in treating dysplastic Barrett’s esophagus: a critical assessment of histologic outcomes and adverse events. Gastrointest Endosc. 2014;79(5):718.CrossRefPubMedGoogle Scholar
  38. 38.
    Shaheen NJ, Greenwald BD, Peery AF, Dumot JA, Nishioka NS, Wolfsen HC, Burdick JS, Abrams JA, Wang KK, Mallat D, Johnston MH, Zfass AM, Smith JO, Barthel JS, Lightdale CJ. Safety and efficacy of endoscopic spray cryotherapy for Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 2010;71(4):680.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Canto MI, Shin EJ, Khashab MA, Molena D, Okolo P, Montgomery E, Pasricha P. Safety and efficacy of carbon dioxide cryotherapy for treatment of neoplastic Barrett’s esophagus. Endoscopy. 2015;47(7):582.CrossRefPubMedGoogle Scholar
  40. 40.
    van Vilsteren FG, Pouw RE, Seewald S, Alvarez Herrero L, Sondermeijer CM, Visser M, Ten Kate FJ, Yu Kim Teng KC, Soehendra N, Rösch T, Weusten BL, Bergman JJ. Stepwise radical endoscopic resection versus radiofrequency ablation for Barrett’s oesophagus with high-grade dysplasia or early cancer: a multicentre randomised trial. Gut. 2011;60(6):765.CrossRefPubMedGoogle Scholar
  41. 41.
    Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, Fullarton G, Di Pietro M, Ravi N, Visser M, Offerhaus GJ, Seldenrijk CA, Meijer SL, ten Kate FJ, Tijssen JG, Bergman JJ. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12):1209–17.CrossRefPubMedGoogle Scholar
  42. 42.
    Small AJ, Araujo JL, Leggett CL, Mendelson AH, Agarwalla A, Abrams JA, Lightdale CJ, Wang TC, Iyer PG, Wang KK, Rustgi AK, Ginsberg GG, Forde KA, Gimotty PA, Lewis JD, Falk GW, Bewtra M. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett’s esophagus and confirmed low-grade Dysplasia. Gastroenterology. 2015;149(3):567.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of UtahSalt Lake CityUSA
  2. 2.Gastroenterology and HepatologyUniversity of Utah School of Medicine, Huntsman Cancer CenterSalt Lake CityUSA

Personalised recommendations