Materiały źródłowe

• #1 Barrett’s Esophagus: An Updated Review

  https://www.mdpi.com/2075-4418/13/2/321

  Barrett’s esophagus (BE) is a change in the distal esophageal mucosal lining, whereby metaplastic columnar epithelium replaces squamous epithelium of the esophagus. This change represents a pre-malignant mucosal transformation which has a known association with the development of esophageal adenocarcinoma. […] Diagnosis of BE is established with a combination of endoscopic recognition, targeted biopsies, and histologic confirmation of columnar metaplasia. […] The diagnosis of Barrett’s esophagus is a combination of several components, including recognition during endoscopy, appropriately targeted biopsies, and histologic confirmation of columnar metaplasia. […] Endoscopic recognition of Barrett’s esophagus requires the presence of columnar epithelium ≥1 cm above the proximal margin of the gastric folds, based on the universally accepted Prague criteria. […] Histologic confirmation of Barrett’s esophagus shows a combination of intestinalized columnar cells, gastric fundic and gastric cardia type cells present in the mucosa.

• #1 Barrett Esophagus: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1000/barrett-esophagus.html

  Barrett esophagus is a premalignant change of the esophagus; however, malignant transformation to esophageal adenocarcinoma is rare in patients without dysplasia. […] Mucosal change consistent with Barrett esophagus is visualized during upper endoscopy; biopsy confirms the diagnosis and determines if dysplasia is present. […] The diagnosis of Barrett esophagus requires two conditions: (1) the normally pale-white esophageal mucosa appears abnormally salmon-colored on endoscopy, at least 1 cm above the gastric folds, and (2) biopsies of the abnormal-appearing esophagus must show columnar epithelium and the presence of goblet cells consistent with intestinal metaplasia. […] The finding of no dysplasia, low-grade dysplasia, or high-grade dysplasia should be reported because this influences management and prognosis.

• #1 Diagnostic Testing for Barrett Esophagus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8132671/

  Barrett esophagus is diagnosed in approximately 10% of patients undergoing endoscopy for chronic symptoms of gastroesophageal reflux disease (GERD), which include heartburn and regurgitation. However, GERD is not the only risk factor for Barrett esophagus; up to 5% of patients without chronic GERD are diagnosed with Barrett esophagus. […] Endoscopy with biopsy is the current standard of care for making a diagnosis of Barrett esophagus. Specifically, endoscopy is used to identify a columnar-lined esophagus in the distal portion. If the columnar lining is 1 cm or greater, biopsies should be obtained from the esophagus. Documented intestinal metaplasia confirms the diagnosis of Barrett esophagus. […] The most important aspect at the time of endoscopy is to recognize the anatomic gastroesophageal junction and determine if columnar lining greater than 1 cm extends above this landmark.

• #1

  https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx

  Most professional guidelines from around the world agree that a diagnosis of BE requires the presence of IM because of an increased risk of EAC associated with IM, although guidelines from the British Society of Gastroenterology and the Asia Pacific region do not require this. […] We suggest that columnar mucosa of at least 1 cm in length be necessary for a diagnosis of BE, and that: a. Patients with a normal-appearing Z line should not undergo routine endoscopic biopsies. b. In the absence of any visible lesions, patients with a Z line demonstrating 1 cm of proximal displacement from the top of the gastric folds should not undergo routine endoscopic biopsies (quality of evidence: low; strength of recommendation: conditional). […] We suggest at least 8 endoscopic biopsies be obtained in screening examinations with endoscopic findings consistent with possible BE, with the Seattle protocol followed for segments of longer than 4 cm (quality of evidence: low; strength of recommendation: conditional).

• #1 Barrett’s Esophagus: Symptoms, Causes, Treatments & Medications

  https://my.clevelandclinic.org/health/diseases/14432-barretts-esophagus

  Barretts esophagus is a change in the cellular structure of your esophagus lining. […] A gastroenterologist, a specialist in gastrointestinal diseases, usually diagnoses Barretts esophagus. Theyll look inside your esophagus for evidence of the tissue changes and take small tissue samples to confirm them (biopsies). Theyll do this in a procedure called an endoscopy. This means putting a tiny camera on a long tube down your throat to examine your esophagus, while youre under sedation. […] In general, normal esophageal lining is pale pink and smooth, while intestinal metaplasia is salmon-colored and coarse. But inflammation in your esophagus could obscure these features. Your provider might need to take multiple biopsy samples from different places to study under a microscope. This is how theyll confirm the structural changes in the cells of your esophagus lining (epithelium). […] If a pathologist confirms you have dysplasia, theyll characterize it as either low-grade or high-grade (mild or severe). Your provider may recommend treatment or more frequent surveillance for low-grade dysplasia. For high-grade dysplasia, theyll recommend treatment to remove the affected tissue.

• #1 Barrett’s Esophagus: Symptoms, Causes, and Treatments

  https://www.webmd.com/heartburn-gerd/barretts-esophagus-symptoms-causes-and-treatments

  How Is Barrett’s Esophagus Diagnosed? […] Because there are often no specific symptoms linked to Barrett’s esophagus, it can only be diagnosed with an upper endoscopy and biopsy. Guidelines from the American Gastroenterological Association recommend screening in people who have multiple risk factors for Barretts esophagus. […] Once the tube is inserted, the doctor can visually inspect the lining of the esophagus. Barrett’s esophagus, if it’s there, is visible on camera, but the diagnosis requires a biopsy. The doctor will remove a small sample of tissue to be examined under a microscope in the laboratory to confirm a diagnosis. […] If the biopsy confirms the presence of Barrett’s esophagus, your doctor will probably recommend a follow-up endoscopy and biopsy to examine more tissue for early signs of cancer.

• #1

  https://journals.lww.com/ajg/fulltext/2016/01000/acg_clinical_guideline__diagnosis_and_management.17.aspx

  Barretts esophagus (BE) is among the most common conditions encountered by the gastroenterologist. […] These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. […] The purpose of this guideline is to review the definition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. […] BE should be diagnosed when there is extension of salmon-colored mucosa into the tubular esophagus extending 1cm proximal to the gastroesophageal junction (GEJ) with biopsy confirmation of IM (strong recommendation, low level of evidence). […] Endoscopic biopsy should not be performed in the presence of a normal Z line or a Z line with 1cm of variability (strong recommendation, low level of evidence).

• #1 Diagnosis of Barrett’s Esophagus – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/diagnosis

  Your doctor may recommend testing for Barretts esophagus if you have weekly symptoms of gastroesophageal reflux disease (GERD) for 5 or more years and at least three other risk factors for Barretts esophagus. […] Doctors most often diagnose Barretts esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. […] Upper GI endoscopy is a test in which a doctor uses an endoscope to see inside your upper GI tract. The test may show changes in the lining of your esophagus. […] During upper GI endoscopy, a doctor takes biopsies by passing small tweezers through the endoscope. […] A pathologist will look at the tissue under a microscope to check for Barretts esophagus cells. […] Barretts esophagus can be hard to diagnose because it doesnt affect all the tissue in your esophagus. The doctor will take biopsy samples from multiple areas of the lining of your esophagus.

• #1

  https://journals.lww.com/ajg/fulltext/2016/01000/acg_clinical_guideline__diagnosis_and_management.17.aspx

  In the presence of BE, the endoscopist should describe the extent of metaplastic change including circumferential and maximal segment length using the Prague classification (conditional recommendation, low level of evidence). […] In patients with suspected BE, at least 8 random biopsies should be obtained to maximize the yield of IM on histology. […] In patients with suspected BE and lack of IM on histology, a repeat endoscopy should be considered in 12 years of time to rule out BE (conditional recommendation, very low level of evidence). […] The definition of BE has varied depending upon the requirement for the presence of IM on endoscopic biopsy. […] The yield for IM correlates directly with the number of endoscopic biopsies obtained. […] In a large retrospective study, the yield for IM was 35% if 4 biopsies were obtained, and up to 68% after 8 biopsies were performed.

• #1 Barrett’s Esophagus Screening and Diagnosis Program | City of Hope

  https://www.cancercenter.com/barretts-esophagus-treatment-program/screening-and-diagnosis

  If youre at risk for Barretts esophagus, you may need further testing, which may include: Upper endoscopy to look inside the esophagus, Biopsy, which takes a small sample of esophageal tissue so an expert can examine the cells under a microscope. […] The test to screen for and diagnose Barretts esophagus involves upper endoscopy and biopsy. […] Our team may diagnose Barretts esophagus based on our view inside the esophagus and the pathologists report on the cells. […] Our gastroenterologists and pathologists have training and experience in identifying these abnormal cell changes, called dysplasia. […] Our Barretts esophagus team will determine whether your cells have: No dysplasia, indicating healthy, unchanged cells, Low-grade dysplasia, Intermediate dysplasia, High-grade dysplasia, which may soon change into cancer.

• #1 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Currently, dysplasia is the primary clinical biomarker used for risk assessment in the surveillance and management of BE patients. […] The rationale for its use as the primary clinical biomarker is based on the premise that EAC in BE patients develops through a sequence of molecular and morphologic changes that begin with intestinal metaplasia and then progress from LGD to HGD, and ultimately to EAC. […] Unfortunately, dysplasia has a number of limitations as a biomarker. […] The most pronounced variability is linked to the diagnosis of LGD, with a recent study illustrating sub-optimal interobserver agreement for LGD even among gastrointestinal (GI) pathologists. […] Consequently, both the American College of Gastroenterology and the American Gastroenterological Association strongly recommend that all potential dysplasia cases be confirmed by at least one experienced GI pathologist before embarking on a management plan.

• #1

  https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx

  We recommend both white light endoscopy and chromoendoscopy in patients undergoing endoscopic surveillance of BE (quality of evidence: moderate; strength of recommendation: strong). […] We recommend a structured biopsy protocol be applied to minimize detection bias in patients undergoing endoscopic surveillance of BE (quality of evidence: low; strength of recommendation: strong). […] We recommend endoscopic surveillance be performed in patients with BE at intervals dictated by the degree of dysplasia noted on previous biopsies (quality of evidence: very low; strength of recommendation: conditional). […] We recommend EET compared with esophagectomy in patients with BE with HGD or IMC (strength of recommendation: strong; quality of evidence: moderate). […] We suggest endoscopic therapy in patients with BE with confirmed LGD to reduce the risk of progression to HGD/EAC, with endoscopic surveillance of confirmed LGD as an acceptable alternative (strength of recommendation: conditional; quality of evidence: moderate).

• #1 Diagnosis and Management of Barrett’s Esophagus with and Without Dysplasia | IntechOpen

  https://www.intechopen.com/chapters/43561

  The significant increase in image resolution by high-resolution endoscopy and high definition monitors (HDTV) is the most important recent improvement in endoscopic imaging in general, and particularly with regard to detection of early neoplastic lesions. […] The diagnosis and grading of dysplasia rely on careful endoscopic and histological examinations in a Barretts segment, confirmed by expert. […] There are no evidence regarding outcome of endoscopic surveillance but all professional organizations recommend this approach for all types of BE.

• #1 Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline | ESGE

  https://www.esge.com/diagnosis-and-management-of-barrett-esophagus

  ESGE recommends careful inspection of the neosquamocolumnar junction and neo-squamous epithelium with high definition white-light endoscopy and virtual chromoendoscopy during post-EET surveillance, to detect recurrent dysplasia. […] ESGE recommends against routine four-quadrant biopsies of neo-squamous epithelium after successful EET of BE. […] ESGE recommends targeted biopsies are obtained where there is a suspicion of recurrent BE in the tubular esophagus, or where there are visible lesions suspicious for dysplasia. […] After successful EET, ESGE recommends the following surveillance intervals: For patients with a baseline diagnosis of HGD or EAC: at 1, 2, 3, 4, 5, 7, and 10 years after last treatment, after which surveillance may be stopped. For patients with a baseline diagnosis of LGD: at 1, 3, and 5 years after last treatment, after which surveillance may be stopped.

• #1

  https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx

  We recommend that dysplasia of any grade detected on biopsies of BE be confirmed by a second pathologist with expertise in gastrointestinal (GI) pathology (quality of evidence: low; strength of recommendation: strong). […] We suggest a single screening endoscopy for patients with chronic GERD symptoms and 3 or more additional risk factors for BE, including male sex, age 50 years, White race, tobacco smoking, obesity, and family history of BE or EAC in a first-degree relative (strength of recommendation: conditional; quality of evidence: very low). […] We suggest that a swallowable, nonendoscopic capsule sponge device combined with a biomarker is an acceptable alternative to endoscopy for screening for BE in those with chronic reflux symptoms and other risk factors (strength of recommendation: conditional; quality of evidence: very low).

• #1 Barrett’s Esophagus – American College of Gastroenterology

  https://gi.org/topics/barretts-esophagus/

  What Type of Tests are Needed to Evaluate Barrett’s Esophagus? Endoscopy is the test of choice for Barrett’s esophagus. During endoscopy, a thin tube with a light and camera on the end is run through your mouth, down your throat and into your stomach. Biopsies, meaning small pieces of tissue can be collected to look at under the microscope. In Barrett’s, tissue is the issue. Tissue, showing a certain abnormal cell type, is necessary to make the diagnosis of Barrett’s esophagus, and is one of the keys to management of Barrett’s. […] Noninvasive testing options, like swallowable capsule sponge devices combined with blood tests, are now a possible new way to get tissue samples and look for Barrett’s. This option is not yet available commercially, as large population studies in the USA have not been published yet. We hope this information will be released soon and improve patient access to minimally invasive testing.

• #1 Diagnostic Testing for Barrett Esophagus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8132671/

  Although it is the gold standard for making a diagnosis of Barrett esophagus, endoscopy with biopsy has certain limitations and complications (although rare). It is an invasive method and requires sedation to be performed, and patients have to take a day off from work in order to undergo the test. […] The diagnostic performance of the new noninvasive tests continues to be tested in studies, and they need to show high accuracy. Cost-effectiveness studies that compare these new tests with endoscopy with biopsy then need to be conducted. […] Even if one of these tests has a positive result, patients will still have to undergo endoscopy to confirm the presence of Barrett esophagus and, more importantly, that there is no dysplasia and/or cancer.

• #1 Barrett’s Esophagus Screening and Diagnosis Program | City of Hope

  https://www.cancercenter.com/barretts-esophagus-treatment-program/screening-and-diagnosis

  If you have heartburn on a regular basis and certain risk factors, an expert should screen you for Barretts esophagus. […] City of Hope has a team that specializes in detecting Barretts esophagus. We offer screening tests to identify problems as early as possible and the expertise to help you understand next steps. […] At City of Hope, our experts recommend screening for Barretts esophagus for people who have both: Weekly, chronic symptoms of GERD (at least once a week for five years or more) and Two or more additional risk factors for Barretts esophagus. […] To diagnose Barretts esophagus, a City of Hope gastroenterologist will meet with you to discuss: Your personal medical history and lifestyle, Your familys medical history, Any symptoms you have, such as heartburn or difficulty swallowing.

• #1 Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline | ESGE

  https://www.esge.com/diagnosis-and-management-of-barrett-esophagus

  ESGE recommends the following standards for Barrett esophagus (BE) surveillance: a minimum of 1-minute inspection time per cm of BE length during a surveillance endoscopy, photodocumentation of landmarks, the BE segment including one picture per cm of BE length, and the esophagogastric junction in retroflexed position, and any visible lesions, use of the Prague and (for visible lesions) Paris classification, collection of biopsies from all visible abnormalities (if present), followed by random four-quadrant biopsies for every 2-cm BE length. […] ESGE suggests varying surveillance intervals for different BE lengths. For BE with a maximum extent of ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE with a maximum extent of ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent of ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies.

• #1

  https://journals.lww.com/ajg/fulltext/2016/01000/acg_clinical_guideline__diagnosis_and_management.17.aspx

  Therefore, in situations where BE is suspected, we recommend acquiring 4 biopsies every 2cm of segment length, or a total of at least 8 biopsies if the segment is 2cm, at the initial exam. […] In patients with suspected BE on endoscopy without confirmation of IM despite adequate number of biopsies, a repeat examination could be considered in 12 years of time based on a longitudinal cohort study demonstrating that 30% of these patients can be expected to demonstrate IM on a repeat examination.

• #1 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Pathologists in many institutions, particularly in the UK and Europe, have advocated for the use of universal p53 IHC in BE cases to detect dysplasia that might be otherwise overlooked. […] The recommendation seemed to reflect studies directed at predicting progression of NDBE to HGD/EAC rather than establishing an initial diagnosis. […] WATS3D or Wide Area Transepithelial Sampling with Three-Dimensional Computer-Assisted Analysis is an adjunct test to targeted and random four-quadrant esophageal biopsies using three-dimensional computer-assisted tissue analysis. […] Several studies have demonstrated a significant increase in the detection rates of BE and dysplasia when WATS3D was used adjunctively to the combination of both targeted and random four-quadrant biopsies. […] TissueCypher uses immunofluorescent labeling of sections from formalin-fixed paraffin-embedded samples for p16, AMACR, p53, HER2, CK20, CD68, COX-2, HIF-1, and CD45RO, together with Hoechst staining dye.

• #1 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Consequently, there is an increased interest in ancillary tests that could (1) improve the diagnostic accuracy of dysplasia (and its grading) in challenging situations to avoid a repeat endoscopic examination with biopsies; (2) predict which NDBE or LGD patients are at a higher risk for developing HGD/EAC; (3) identify patients who are less likely to develop HGD/EAC so that the surveillance of low-risk patients can be reduced; and/or (4) predict those more likely to have a poor response to endoscopic therapy. […] Although none of these studies have comprehensively evaluated the potential utility of these biomarkers in reducing mortality from EAC compared with the current surveillance standards, they have demonstrated a potential benefit when used in combination with histologic findings to assist in the diagnosis and/or risk stratification of BE and dysplasia.

• #1 CDx Diagnostics | Find heartburn or Barrett’s esophagus patients

  https://www.cdxdiagnostics.com/wats3d-patients

  WATS3D is an advanced tool that helps your doctor examine the cells in your esophagus during an upper endoscopy. If determined to be medically necessary, your doctor may use this technology, which is supported by artificial intelligence and expert doctors, to find unhealthy cell changes that regular tests might miss. […] CDx Diagnostics is a leader in early esophageal precancer detection with over 400,000 cases analyzed in 10 years. We help physicians improve patient care and prevent esophageal cancer, striving to make a positive impact on every patients health. […] WATS3D is a test performed during an upper endoscopy (EGD) to detect precancerous cells early, providing crucial information to guide treatment and prevent gastrointestinal disease. […] At CDx, we provide accurate and reliable results to help your doctor make informed treatment decisions. Our focus on early detection aims to prevent cancer from developing.

• #1 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Barretts esophagus is considered a precancerous condition, because it can progress into esophageal adenocarcinoma, commonly known as esophageal cancer. […] An estimated 5% of people with Barretts esophagus will develop esophageal cancer over the course of their lifetime. […] Because of this, the primary method of preventing esophageal adenocarcinoma is screening for Barretts esophagus and treating precancerous tissue before it can progress to cancer. […] Screening for Barretts esophagus makes it possible to detect and treat dysplastic tissue before it can progress to esophageal cancer. […] During this procedure, a clinician examines the entire length of the esophagus with a tool called an endoscope to look for changes in the esophageal tissues appearance. […] Detecting and treating dysplastic Barretts esophagus is an extremely effective way to prevent esophageal adenocarcinoma. […] TissueCypher is an artificial intelligence-driven, precision medicine test to predict the risk of progression from Barretts esophagus to cancer, which can identify patients that show no signs of dysplasia but are at high risk of progressing to cancer in the future.

• #1 Barrett’s Oesophagus – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/barretts-oesophagus/

  Barrett’s oesophagus is diagnosed by examining the oesophagus lining using a procedure called endoscopy. This is a test performed by a specialist where a small tube (the width of a small finger), with a camera on the end is inserted into the oesophagus and stomach via the mouth or nose. Sedation can be used to make the procedure more comfortable. The area of interest is where the oesophagus meets the stomach (gastro-oesophageal junction). Barrett’s oesophagus is identified when, instead of a normal whitish lining, a pinker lining is seen that extends from the junction and up the oesophagus. Biopsies (a small sample of tissue) are then taken to confirm diagnosis and look for abnormal cells (dysplasia). A pathologist will grade the dysplasia into high grade or low grade. If low grade dysplasia is found, then a repeat endoscopy in 6 months is ordered to reassess and consider if referral to a specialist centre for treatment is needed. Patients found to have high grade dysplasia are typically referred more quickly to a specialist centre, as the risk of progression to cancer is higher.

• #2

  https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx

  Barrett’s esophagus (BE) is a common condition associated with chronic gastroesophageal reflux disease. BE is the only known precursor to esophageal adenocarcinoma, a highly lethal cancer with an increasing incidence over the last 5 decades. These revised guidelines implement Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the definition and diagnosis of BE, screening for BE and esophageal adenocarcinoma, surveillance of patients with known BE, and the medical and endoscopic treatment of BE and its associated early neoplasia. […] In this revised guideline, the American College of Gastroenterology (ACG) offers recommendations for the diagnosis, screening, surveillance, and endoscopic and medical therapy of BE. […] We suggest that a diagnosis of BE require the finding of intestinal metaplasia (IM) in the tubular esophagus (conditional recommendation, very-low-quality evidence).

• #2 ‘Undiagnosing’ Barrett’s a Frequent Task for Esophageal Experts

  https://www.gastroendonews.com/In-the-News/Article/02-21/-Undiagnosing-Barrett-s-a-Frequent-Task-for-Esophageal-Experts/62459?sub=CD3BC2797BEA17C91A4A22245CED6B49E47BCEFA9C4CCF6B129B7D2AF5689CDD

  Evidence-based guidelines discourage biopsies for Barretts esophagus unless patients meet specific criteria on endoscopic evaluation. […] A diagnosis of Barretts requires evidence on endoscopy with biopsy confirmation of intestinal metaplasia extending at least 1 cm into the esophagus proximal to the gastroesophageal junction, or Z line. […] All these variables lead to the recommendation in the guidelines against biopsy of a normal-appearing Z line or a Z line with less than 1 cm of irregularity. […] If the squamocolumnar junction and the top of the gastric folds are at the same location, they dont have Barretts. […] The first step toward reducing un-Barretts diagnoses is to prevent Barretts overdiagnoses. […] The risk for a patient with intestinal metaplasia of the gastric cardia getting cancer in the next decade is less than 1%.

• #2 Barrett Esophagus: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/171002-overview

  The following techniques are used in the diagnosis and assessment of Barrett esophagus: […] Esophagogastroduodenoscopy (EGD): The procedure of choice for the diagnosis of Barrett esophagus […] Biopsy: The diagnosis of Barrett esophagus requires biopsy confirmation of specialized intestinal metaplasia (SIM) in the esophagus […] The Practice Parameters Committee of the American College of Gastroenterology recommends that patients with long-standing GERD symptoms (5 yr), particularly those aged 50 years or older, have an upper endoscopy to detect or screen for Barrett esophagus.

• #2 Barrett’s esophagus diagnosis

  https://www.mayoclinic.org/diseases-conditions/barretts-esophagus/multimedia/barretts-esophagus-diagnosis/img-20005670

  Barrett’s esophagus has a distinct appearance when viewed during an endoscopy exam. During endoscopy, the doctor passes a flexible tube with a video camera at the tip (endoscope) down your throat and into the swallowing tube (your esophagus). The video camera detects surface abnormalities, such as acid reflux damage or the presence of a hiatal hernia or ulcers, as well as Barrett’s esophagus.

• #2 Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline | ESGE

  https://www.esge.com/diagnosis-and-management-of-barrett-esophagus

  ESGE recommends the following standards for Barrett esophagus (BE) surveillance: a minimum of 1-minute inspection time per cm of BE length during a surveillance endoscopy, photodocumentation of landmarks, the BE segment including one picture per cm of BE length, and the esophagogastric junction in retroflexed position, and any visible lesions, use of the Prague and (for visible lesions) Paris classification, collection of biopsies from all visible abnormalities (if present), followed by random four-quadrant biopsies for every 2-cm BE length. […] ESGE suggests varying surveillance intervals for different BE lengths. For BE with a maximum extent of ≥ 1 cm and < 3 cm, BE surveillance should be repeated every 5 years. For BE with a maximum extent of ≥ 3 cm and < 10 cm, the interval for endoscopic surveillance should be 3 years. Patients with BE with a maximum extent of ≥ 10 cm should be referred to a BE expert center for surveillance endoscopies.

• #2 Diagnosing Barrett’s Esophagus | NYU Langone Health

  https://nyulangone.org/conditions/barretts-esophagus/diagnosis

  NYU Langone doctors are experts in diagnosing Barretts esophagus, a condition in which precancerous changes occur in the cells that line the esophagus, the muscular tube that carries food and liquids from the mouth to the stomach. […] To diagnose Barretts esophagus, an NYU Langone gastroenterologist takes a detailed medical history and conducts a physical exam. He or she also performs an upper endoscopy. If abnormal cells are found, your doctor may perform a biopsy at the same time as the endoscopy. […] Doctors perform an upper endoscopy to identify any precancerous cells. During this procedure, the doctor examines the entire length of the esophagus, including the gastroesophageal junction, where the esophagus joins the stomach. […] If the lining of the esophagus looks abnormal, the doctor performs a biopsy to determine whether you have Barretts esophagus.

• #2

  https://journals.lww.com/ajg/fulltext/2016/01000/acg_clinical_guideline__diagnosis_and_management.17.aspx

  In the presence of BE, the endoscopist should describe the extent of metaplastic change including circumferential and maximal segment length using the Prague classification (conditional recommendation, low level of evidence). […] In patients with suspected BE, at least 8 random biopsies should be obtained to maximize the yield of IM on histology. […] In patients with suspected BE and lack of IM on histology, a repeat endoscopy should be considered in 12 years of time to rule out BE (conditional recommendation, very low level of evidence). […] The definition of BE has varied depending upon the requirement for the presence of IM on endoscopic biopsy. […] The yield for IM correlates directly with the number of endoscopic biopsies obtained. […] In a large retrospective study, the yield for IM was 35% if 4 biopsies were obtained, and up to 68% after 8 biopsies were performed.

• #2

  https://journals.lww.com/ajg/fulltext/2022/04000/diagnosis_and_management_of_barrett_s_esophagus_.17.aspx

  We recommend that dysplasia of any grade detected on biopsies of BE be confirmed by a second pathologist with expertise in gastrointestinal (GI) pathology (quality of evidence: low; strength of recommendation: strong). […] We suggest a single screening endoscopy for patients with chronic GERD symptoms and 3 or more additional risk factors for BE, including male sex, age 50 years, White race, tobacco smoking, obesity, and family history of BE or EAC in a first-degree relative (strength of recommendation: conditional; quality of evidence: very low). […] We suggest that a swallowable, nonendoscopic capsule sponge device combined with a biomarker is an acceptable alternative to endoscopy for screening for BE in those with chronic reflux symptoms and other risk factors (strength of recommendation: conditional; quality of evidence: very low).

• #2 Barrett’s Esophagus: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/esophageal-diseases/barretts-esophagus/treatment

  How is Barretts Esophagus Diagnosed? Diagnosis The care of people with Barretts esophagus is optimized using a team of specialists. Your team at NewYork-Presbyterian will include gastroenterologists, interventional endoscopists, surgeons, radiologists, nutritionists, nurses, and others with the clinical expertise, compassion, and skills to provide the highest quality care. […] The most effective care for Barretts esophagus begins with an accurate diagnosis. […] To determine if you have this disorder and to assess its severity, our doctors use the following to diagnose Barretts esophagus: […] High-definition white light endoscopy. By inspecting the inside of your esophagus using a flexible tube with a camera at its tip, your gastroenterologist can see and remove abnormal tissue to determine if you have Barretts esophagus. […] Narrow band imaging (NBI) uses a special system to capture high-resolution images of the inner surface of your esophagus. Using light of different wavelengths, your doctor can see fine features of the tissue in your esophagus and determine if it has been damaged or changed.

• #2 Diagnosis of Barrett’s Esophagus | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/barretts-esophagus/diagnosis.html

  To accurately diagnose Barrett’s esophagus, you may need one or more tests, including: Confocal microscopy: This test uses a special microscope to create high-resolution, 3-D images of your esophagus. Upper endoscopy: We pass a small flexible tube (endoscope) and tiny camera through your mouth and esophagus to examine the lining of your esophagus. During this test, we may also take a biopsy.

• #2 Diagnosis and Management of Barrett’s Esophagus

  https://www.mdpi.com/2077-0383/12/6/2141

  One of the most promising novel methods for BE diagnosis is a Cytosponge—a gelatin capsule attached to a string. The capsule is meant to dissolve 5 min after being swallowed, enabling the device hidden inside to expand. Afterward, the apparatus is retrieved by pulling on the string, and as it passes through the esophagus, it collects the tissue specimen. The sampling is then analyzed using immunostaining for trefoil factor 3, a diagnostic marker of BE. Cytosponge was proven to be more cost-effective than endoscopy due to its higher uptake. […] The goal of diagnosing and further screening in BE patients is early detection of dysplasia and EAC. According to a multicenter U.S. study the majority of patients diagnosed with BE do not have dysplasia (70.1% non-dysplastic BE vs. 16.9% low-grade dysplasia and high-grade dysplasia). Appropriate management and surveillance may reduce the morbidity and mortality associated with EAC.

• #2 Barrett’s Oesophagus – Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/barretts-oesophagus/

  How is Barrett’s Oesophagus diagnosed? Cytosponge TFF3. This is a new test that is available in some areas of the UK to identify Barrett’s oesophagus in people who have persistent heartburn and reflux symptoms. For the Cytosponge test you will be asked to swallow a small capsule with a sponge inside, which is attached to a piece of thread. Approximately 7 minutes after swallowing it, the capsule dissolves in the stomach, and the sponge inside is released. A nurse will then gently pull the thread to remove the sponge. On the way out the sponge collects cells from the lining. The cells are then examined in the laboratory to check if there are any changes in the cells using a special stain called TFF3. If this does show cell changes you will then be asked to attend for an endoscopy to confirm whether there is Barrett’s present.

• #2 Barrett’s Esophagus: Diagnosis and Treatment

  https://www.medscape.org/viewarticle/463423

  Barrett’s esophagus (BE) has been recognized as the link between gastroesophageal reflux disease (GERD) and esophageal adenocarcinoma. […] This report discusses the most clinically relevant findings and places them in appropriate context for the practicing physician. […] A retrospective chart review was conducted to record patients who underwent endoscopy and were diagnosed with suspected BE over a 9-year period. […] The annual incidence of new cases of suspected BE on endoscopy was obtained and all biopsy results were also reviewed to confirm the presence of intestinal metaplasia. […] These preliminary data suggest that there may indeed have been a true increase in the incidence of BE. […] BE is detected in 10% to 15% of patients with gastroesophageal reflux disease (GERD) symptoms, but has also recently been detected in a similar percentage of asymptomatic individuals.

• #2 Barrett Esophagus: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/1000/barrett-esophagus.html

  Screening for Barrett esophagus is done by sedated upper endoscopy. […] There is no evidence from prospective studies that screening for Barrett esophagus in patients with GERD improves mortality or quality of life; therefore, Canadian and British guidelines recommend against universal screening for patients who have GERD. […] The American College of Gastroenterology acknowledges that evidence is insufficient, but based on expert consensus, suggests selective screening for Barrett esophagus in people with chronic or frequent GERD symptoms plus two additional risk factors, including age older than 50 years.

• #2 Barrett’s Esophagus: Causes, Risk Factors, and Symptoms

  https://www.healthline.com/health/barretts-esophagus

  Barretts esophagus is usually diagnosed by performing an endoscopy. […] During this procedure, a healthcare professional uses an endoscope a tube with a small camera and light on it to see the inside of your esophagus. […] A doctor may also perform a biopsy to confirm the diagnosis of Barretts esophagus. […] The ACG recommends males get tested for Barretts esophagus if theyve experienced GERD symptoms for 5 years and have at least two risk factors.

• #2 Common Questions About Barrett Esophagus | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0115/p92.html

  Surveillance endoscopy is recommended every three to five years for patients with Barrett esophagus without dysplasia, every six to 12 months for those with low-grade dysplasia, and every three months for those with high-grade dysplasia (if not eradicated). […] Because of their higher rate of progression to esophageal adenocarcinoma, lesions with high-grade dysplasia should generally be eradicated. Any mucosal irregularities such as ulcers or nodules found on examination should be resected endoscopically for diagnosis and staging. Endoscopic methods are now largely preferred over invasive esophagectomy.

• #2 Patient education: Barrett’s esophagus (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/barretts-esophagus-beyond-the-basics/print

  If the endoscopic appearance suggests Barrett’s esophagus, the doctor will remove a small sample of the lining (a biopsy) during the endoscopy so that it can be examined with a microscope for signs of Barrett’s. […] Endoscopy detects most (>80 percent) but not all cases of Barrett’s esophagus. Individual variations in the anatomy of the esophagus and the area where it meets the stomach can make the diagnosis of Barrett’s esophagus difficult in some people.

• #2 Diagnostic Testing for Barrett Esophagus

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8132671/

  Although it is the gold standard for making a diagnosis of Barrett esophagus, endoscopy with biopsy has certain limitations and complications (although rare). It is an invasive method and requires sedation to be performed, and patients have to take a day off from work in order to undergo the test. […] The diagnostic performance of the new noninvasive tests continues to be tested in studies, and they need to show high accuracy. Cost-effectiveness studies that compare these new tests with endoscopy with biopsy then need to be conducted. […] Even if one of these tests has a positive result, patients will still have to undergo endoscopy to confirm the presence of Barrett esophagus and, more importantly, that there is no dysplasia and/or cancer.

• #2 Barrett’s Esophagus: Diagnosis and Treatment

  https://www.medscape.org/viewarticle/463423

  Another area of intense research in the setting of BE is the study of biomarkers that may predict an increased risk of progression to cancer. […] The incidence of cancer in patients with BE who are treated either with medical or surgical therapy has been reported to be similar. […] These provocative results from a retrospective analysis raise the possibility that PPI therapy may alter the progression of BE to dysplasia, and emphasizes the role of acid suppression in the treatment of patients with BE. […] These mid-term follow-up results show that the majority of patients (85% in this series) treated with endoscopic ablation with acid-suppression therapy continue to remain free of endoscopic and histologic BE on follow-up. […] Whether such therapy prevents cancer development is yet unknown, and its role in the treatment of BE remains investigational.

• #2 Utility of ancillary studies in the diagnosis and risk assessment of Barrett’s esophagus and dysplasia | Modern Pathology

  https://www.nature.com/articles/s41379-022-01056-0

  Mutational load (ML) analysis provides a measure of cumulative genetic aberrations and instability at 10 key genomic loci by assessing DNA damage around tumor suppressor genes associated with progression to HGD/EAC. […] FISH (fluorescent in situ hybridization) is a technique that utilizes fluorescently labeled DNA probes to detect chromosomal abnormalities. […] Since the 1980s, a number of studies have consistently demonstrated the potential utility of DNA flow cytometry in the diagnosis and risk stratification of dysplasia in BE patients. […] In conclusion, as the current surveillance methods based on the histologic diagnosis and classification of dysplasia imperfectly assess the risk of BE patients, especially those with IND or NDBE histology, there is an increasing demand for ancillary tests to aid in the diagnosis/grading of dysplasia and risk stratification of BE patients.

• #2 Diagnosing Barrett’s Esophagus | NYU Langone Health

  https://nyulangone.org/conditions/barretts-esophagus/diagnosis

  Specialists at NYU Langone may use a newer biopsy technique called wide area transepithelial sampling. […] If the biopsy results indicate that you have Barretts esophagus with little or no dysplasia, your doctor may choose to monitor you closely and prescribe a combination of medication and lifestyle changes to manage GERD. If the biopsy results indicate dysplasia, in which the cells are precancerous, your doctor may recommend more aggressive treatment with minimally invasive endoscopic procedures. […] Sometimes our specialists can identify precancerous cells in the esophagus using this technique. They may be able to diagnose Barretts esophagus without performing a biopsy.

• #2 CDx Diagnostics | Find heartburn or Barrett’s esophagus patients

  https://www.cdxdiagnostics.com/wats3d-patients

  WATS3D is an advanced tool that helps your doctor examine the cells in your esophagus during an upper endoscopy. If determined to be medically necessary, your doctor may use this technology, which is supported by artificial intelligence and expert doctors, to find unhealthy cell changes that regular tests might miss. […] CDx Diagnostics is a leader in early esophageal precancer detection with over 400,000 cases analyzed in 10 years. We help physicians improve patient care and prevent esophageal cancer, striving to make a positive impact on every patients health. […] WATS3D is a test performed during an upper endoscopy (EGD) to detect precancerous cells early, providing crucial information to guide treatment and prevent gastrointestinal disease. […] At CDx, we provide accurate and reliable results to help your doctor make informed treatment decisions. Our focus on early detection aims to prevent cancer from developing.

• #2 What Should I Know about Barrett’s Esophagus and Risk for Esophageal Cancer? | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/news/what-should-know-about-barrett-s-esophagus-and-risk-esophageal

  Thoracic surgeon Daniela Molena says Barretts esophagus results when cells of the esophagus thicken after being bathed in stomach acid. […] Barretts esophagus is considered a precancerous condition and increases esophageal cancer risk. While only a small percentage of patients with Barretts esophagus end up developing esophageal cancer, it is important to monitor the condition in case it begins to progress. […] Doctors use a technique called endoscopy to diagnose and stage Barretts esophagus. In this test, a gastroenterologist puts a thin, flexible tube with a light and a camera at the tip, called an endoscope, down the throat to look at the lining of the esophagus. […] The pathologist can determine how far along the Barretts esophagus is and whether it has become precancerous or cancerous and has the potential to spread to other areas of the body.

• #2 Understanding Barrett’s Esophagus Diagnosis and Cancer Risk

  https://castlebiosciences.com/patient-information/gastroenterology/barretts-esophagus/overview

  Barretts esophagus is considered a precancerous condition, because it can progress into esophageal adenocarcinoma, commonly known as esophageal cancer. […] An estimated 5% of people with Barretts esophagus will develop esophageal cancer over the course of their lifetime. […] Because of this, the primary method of preventing esophageal adenocarcinoma is screening for Barretts esophagus and treating precancerous tissue before it can progress to cancer. […] Screening for Barretts esophagus makes it possible to detect and treat dysplastic tissue before it can progress to esophageal cancer. […] During this procedure, a clinician examines the entire length of the esophagus with a tool called an endoscope to look for changes in the esophageal tissues appearance. […] Detecting and treating dysplastic Barretts esophagus is an extremely effective way to prevent esophageal adenocarcinoma. […] TissueCypher is an artificial intelligence-driven, precision medicine test to predict the risk of progression from Barretts esophagus to cancer, which can identify patients that show no signs of dysplasia but are at high risk of progressing to cancer in the future.

• #2 Update on Barrett Esophagus Diagnosis and Management – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/may-2023/update-on-barrett-esophagus-diagnosis-and-management/

  Endoscopic screening of Barrett esophagus has not had an impact on EAC prevention, and it is time for gastroenterologists to recognize that we have failed. […] Endoscopic identification with biopsy confirmation is still the gold standard for Barrett esophagus diagnosis. […] The ACG guidelines recommend obtaining at least 8 endoscopic biopsies in screening examinations. The more biopsies obtained, the more likely it is to diagnose Barrett esophagus. […] Family history is now one of the risk factors used to help define screening. […] The biomarker TFF3 in the United Kingdom and methylated vimentin and methylated cyclin A1 in the United States are being evaluated for nonendoscopic detection of Barrett esophagus.

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