Materiały źródłowe

• #1 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma – Implications for Screening and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7887893/

  The population prevalence of BE is a crucial statistic upon which all primary and secondary prevention strategies are based, yet it remains largely unknown primarily due to the fact that many individuals with BE are asymptomatic. The BE prevalence in selected populations such as endoscopic or surgical series is no substitute, and so there are few studies that provide an accurate estimate. The first reliable study, published in 1990, assessed the prevalence of long-segment BE in a large series of randomly selected subjects for autopsy and compared this to a prevalence from the endoscopy practice of the Mayo Clinic. The finding of four BE cases was approximately 21 times of that which was expected (0.19), and this equated to an age- and sex-adjusted BE prevalence estimate of 376 per 100,000 population (0.376%). Other estimates of BE population prevalence come from randomly selected populations to undergo endoscopy. A Swedish study of 1,000 randomly selected volunteers detected a total of 16 cases of BE, five of which were classified as long-segment BE (=2 cm), yielding population prevalences of 1.6% and 0.5%, respectively. An Italian study of 1,033 adults reported a BE population prevalence of 1.3% (0.2% for long segment and 1.1% for short segment). A computer simulation disease model has also been used to estimate the population prevalence of BE. Aligning simulation models with EA rates from the US Surveillance Epidemiology and End Results (SEER) cancer registry data, the authors estimated a BE population prevalence of 5.6%. Thus, in predominantly European ancestral populations, estimates for BE population prevalence range from 0.4% to 5.6%. Perhaps surprisingly, Asian countries may also have BE population prevalences in this range, despite the lower incidence of EA. A recent meta-analysis of four Asian-based studies indicated a BE population prevalence of 0.7%, and a Taiwan-based study of 3,385 subjects undergoing routine esophagogastroduodenoscopy examination as part of a health check-up provided a BE population prevalence of 2.6%. The Taiwan study provided details of segment length, showing that the vast majority of diagnoses were short-segment BE, a characteristic that has previously been described in other selected endoscopic series from Asian countries, and which is in accordance with the lower incidence of EA in Asian populations.

• #2 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4449458/

  Barretts esophagus (BE) is a common condition, and is the precursor to esophageal adenocarcinoma, a disease with increasing burden in the western world, especially in Caucasian males. The incidence of BE increased dramatically during the late-20th century and incidence estimates continue to increase, with a prominent male:female ratio. The prevalence is between 0.5 2.0 percent. […] The incidence of EAC in patients with BE is considerably higher than that in the general population, but only a minority of BE patients develop EAC, with annual risk estimated at 0.10.5%. […] Given that the utilization of endoscopy is dependent on the patients socioeconomic status, access to care, and other non-medical factors, the incidence of BE has historically been very difficult to ascertain. However, the incidence of endoscopically-detected BE appears to have increased dramatically over the past 30 years, a finding partially attributable to the increasing frequency of endoscopy during the same period.

• #3 Barrett’s esophagus: Epidemiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/barretts-esophagus-epidemiology-clinical-manifestations-and-diagnosis

  Barrett’s esophagus is usually discovered during endoscopic examinations of middle-aged and older adults; the large majority of cases go unrecognized. The mean age at diagnosis of Barrett’s esophagus is approximately 55 years. Barrett’s esophagus is uncommon in children in general and extremely rare in children under the age of five. Barrett’s esophagus is two- to threefold more common in men than in women. […] In the United States it is estimated that as many as 5.6 percent of adults have Barrett’s esophagus. However, estimates of the prevalence of Barrett’s esophagus in the general population have varied widely ranging from 0.4 to more than 20 percent depending, in part, upon the population studied and the criteria used to establish the diagnosis. […] In studies performed in the United States, Barrett’s esophagus appears to have a higher prevalence in White individuals as compared with individuals who identify as being of Hispanic descent or Asian descent, and prevalence appears to be lowest in Black individuals. The prevalence of short-segment Barrett’s esophagus is substantially higher than long-segment Barrett’s esophagus. Both conditions are diagnosed more frequently in patients age 50 years and older. In a study that included 889 patients undergoing upper endoscopy who had protocol biopsies obtained at the esophagogastric junction, the overall prevalence of specialized intestinal metaplasia was 13.2 percent. The prevalence of short-segment and long-segment Barrett’s were 6.0 and 1.6 percent, respectively. Intestinal metaplasia was limited to the gastroesophageal junction (GEJ) in 5.6 percent.

• #4 Barrett Esophagus: Rapid Evidence Review | AAFP

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

  Barrett esophagus is estimated to affect up to 5.6% of the U.S. population. […] Risk factors for Barrett esophagus include gastroesophageal reflux disease, obesity, age older than 50 years, male sex, tobacco use, and a family history of Barrett esophagus or esophageal adenocarcinoma. […] Surveillance after diagnosis is recommended to monitor for dysplasia and diagnose and treat esophageal adenocarcinoma at an earlier stage. […] The estimated prevalence of Barrett esophagus, including asymptomatic patients, is up to 5.6% of the U.S. population, based on computer modeling. […] The prevalence of Barrett esophagus is based on several risk factors: Low-risk, general population = 0.8%; Obesity = 1.9%; Gastroesophageal reflux disease (GERD) = 3%; Age older than 50 years = 6.1%; Male sex = 6.8%; GERD plus any additional risk factor = 12%; Family history of Barrett esophagus or esophageal adenocarcinoma = 23%.

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

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

  The average age of patients with Barrett esophagus is 55-65 years. The condition occurs in a 3:1 male-to-female ratio, with white males making up more than 80% of cases. Some studies indicate a higher prevalence of smoking, alcohol intake, and obesity in persons with the disease. Estimates of the prevalence of Barrett esophagus vary considerably and range from 0.9-10% of the general adult population. […] A study from Sweden by Ronkainen and colleagues estimated the prevalence to be approximately 2% in the adult population. This particular study is believed to be one of the more reliable because of the means by which the epidemiologic data could be assessed in Sweden. In US population terms, this prevalence would equate to approximately 3 million adults with Barrett esophagus. […] The prevalence of long-segment Barrett esophagus (LSBE) in patients undergoing endoscopy for any clinical indication has been reported at 0.3-2% but is much higher, 5-15%, in patients with symptoms of GERD. A study conducted at the Mayo Clinic showed an autopsy prevalence about 17 times higher than a clinically matched population, suggesting that most cases of LSBE are asymptomatic and thus unrecognized. In patients undergoing endoscopy, the prevalence of SSBE ranges from 5-30%. The combined prevalence of SSBE and cardia-SIM is 7-8 times greater than LSBE, but the prevalence of dysplasia and cancer is much less. […] Current clinical practice guidelines recommend screening for Barrett esophagus in patients with GERD who have had long-standing symptoms (5 y); this is especially recommended in white males who are older than 50 years, have central obesity, and symptoms.

• #6 Barrett’s Esophagus: An Updated Review

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

  Risk factors for Barrett’s esophagus in the general population vary widely based upon the studied population, from 0.4 to 20 percent overall worldwide. In the United States, Barrett’s esophagus shows the highest prevalence in White individuals over 50 years of age as compared to Hispanic or Asian descent, and lowest in Black individuals. […] Although screening for Barrett’s esophagus in the general population is not routinely recommended, it may be considered in men with chronic (>5 years) and/or frequent (weekly or more) symptoms of gastroesophageal reflux and two or more risk factors. […] Current Barrett’s esophagus surveillance guidelines are based largely on expert opinion from the three major gastrointestinal organizations in the United States, the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), and the American Society for Gastrointestinal Endoscopy (ASGE).

• #7 Barrett’s esophagus: best practices for treatment and post-treatment surveillance – Mansour- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/14105/html

  Barretts esophagus (BE) is a premalignant condition that increases the risk of esophageal adenocarcinoma (EAC). Significantly more common in the Western world, risk factors include increased age, male sex, white race, gastro-esophageal reflux disease (GERD), central obesity, and cigarette smoking. Screening for BE is recommended in patients with GERD and additional risk factors. Endoscopic surveillance of patients with BE likely improves overall outcomes. […] Endoscopic surveillance in patients with known BE has been advocated by multiple professional societies, with the goal of detecting dysplasia or early EAC so that curative treatment can be offered prior to the development of advanced EAC. […] The principles of endoscopic surveillance in BE include careful inspection of the Barretts mucosa with high-definition white light endoscopy (HDWLE).

• #8 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma – Implications for Screening and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7887893/

  Assessing incidence trends of BE is a near impossibility due to the large pool of asymptomatic, undiagnosed subjects that we estimate to exist in most populations. As such, the best estimates are derived from clinical data with the hope that these may mirror relative change of all BE cases, including those never diagnosed. Typically, the denominator in such studies is the number of endoscopies, rather than the total population at risk. […] In the US, the first report of BE incidence was from the Mayo Clinic which found a rate of 9.5 per 1,000 endoscopies per annum that was stable over the period 1965 to 1986; the crude rate did dramatically increase but this was wholly accounted for by a similar increase in the number of endoscopies. Two other US studies also presented evidence for no change in BE incidence through the 1990s, once adjusted for number of endoscopies. However, a fourth US study did provide evidence for an increase. The authors found that endoscopy suspected BE increased from 32.2 to 82.8 per 1,000 endoscopies and histologically diagnosed BE from 6.7 to 27.6 per 1,000 endoscopies during 1991 to 2000. More recent studies covering the mid-90s through 2010 indicate that BE incidence has been stable and then may have declined.

• #9 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4449458/

  Data from the U.K. and the Netherlands however, suggest that incidence rate of BE have increased even after controlling for increasing endoscopy rates. These estimates place the increase in BE incidence at near 65% between 1997 and 2002 and 159% between 1993 and 2005. Alarmingly, the greatest proportional increase in BE diagnosis was in those under age 60, in agreement with other work from Europe. […] Dysplastic changes seen on biopsy predict progression of Barretts to esophageal adenocarcinoma, but estimates of the incidence of EAC in dysplastic Barretts epithelium vary.

• #10

  https://www.bumrungrad.com/en/health-blog/june-2024/key-insights-for-effective-screening-surveillance

  Barrett’s Esophagus (BE) is a condition where the normal lining of the esophagus is replaced with tissue similar to the intestine, often due to prolonged exposure to stomach acid. Recognized as a precancerous condition, BE increases the risk of esophageal cancer, making vigilant screening and surveillance crucial for early detection and intervention. […] Surveillance is essential for detecting early precancerous or cancerous changes in BE, significantly enhancing treatment success. Patients with BE, especially those showing dysplasia or abnormal cell growth, have a higher risk of esophageal adenocarcinoma (EAC). Regular surveillance allows for timely treatments, potentially preventing the progression to advanced cancer and improving survival rates. […] Surveillance intervals vary based on factors such as the presence of dysplasia and the length of the BE segment. Generally, patients with BE without dysplasia undergo surveillance every 3 to 5 years. Those with low-grade dysplasia might require checks every 6 to 12 months. Your healthcare provider will customize surveillance frequency to match your specific risk profile.

• #11 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma – Implications for Screening and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7887893/

  In contrast to the US, a majority of European studies have suggested an increase in BE incidence including Scotland, UK, Switzerland, the Netherlands, Spain, and Northern Ireland, as has a study from Australia. The most recent European study from the UK and the Netherlands provides evidence for a decrease and then stabilization of BE incidence. […] The central problems in primary prevention (screening) and secondary prevention (surveillance) of EA is the large undiagnosed BE population and the suboptimal ability to triage risk in the diagnosed BE population, respectively. The large undiagnosed BE population results in a majority of EA cases presenting with late stage disease and a resultant poor prognosis. […] There is a major caveat to this section. A vast majority of the studies that are described have been conducted using selected BE populations; that is, patients who present with symptoms that merit endoscopic and histologic investigation. This should not be glossed over and it is an inherent limitation of studying a rare, largely asymptomatic condition that is expensive and difficult to diagnose.

• #12 Barrett’s esophagus: Surveillance and management – UpToDate

  https://www.uptodate.com/contents/barretts-esophagus-surveillance-and-management

  Barrett’s esophagus: Epidemiology, clinical manifestations, and diagnosis […] The management of Barrett’s esophagus has been addressed in several society guidelines, including a guideline from the American College of Gastroenterology, a guideline from the British Society of Gastroenterology, guidelines from the American Society of Gastrointestinal Endoscopy, and a guideline and expert reviews from the American Gastroenterological Association. […] Estimates of the annual cancer incidence in patients with Barrett’s esophagus have ranged from 0.1 to almost 3.0 percent, with other studies suggesting rates closer to 0.1 to 0.4 percent per year. […] Although the risk of developing esophageal cancer is increased at least 30-fold above that of the general population, the absolute risk of developing cancer for an individual patient with nondysplastic Barrett’s esophagus is low.

• #13 Recent Advances In Surveillance of Patients With Barrett’s Esophagus

  https://www.gastroendonews.com/Review-Articles/article/10-18/Recent-Advances-In-Surveillance-of-Patients-With-Barretts-Esophagus/53105?sub=342B74F8A43CFCB47E522DB6ED273FC7E122A76F7DA71C7304E7A8B1C7E1DAF

  Barretts esophagus (BE), the precursor lesion and the most important risk factor for esophageal adenocarcinoma (EAC), has an estimated prevalence of 5.6% in the adult US population. […] Compared with the general population, patients with BE are 30 to 125 times more likely to develop EAC, with an annual incidence of 0.2% to 0.4%. […] Although all guidelines recommend surveillance of BE patients, given the overall low risk for progression of BE to EAC, a risk-stratified approach may make surveillance more cost-effective. […] Multiple challenges remain for the accurate risk stratification and detection of dysplasia in patients with BE undergoing surveillance, given the overall low rate of BE progression to neoplasia and the patchy distribution of the disease. Recently published data using the PIB score will aid in risk-stratifying patients with BE at high versus low risk for progression to HGD/cancer. […] Finally, the use of advanced techniques, such as acetic acid CE, virtual CE, and WATS, can improve the effectiveness of surveillance programs.

• #14 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.

• #15 Barrett’s esophagus: surveillance best practices – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/news/barretts-esophagus-surveillance-best-practices/

  Barrett’s esophagus — a complication of chronic gastroesophageal reflux disease (GERD) — is a premalignant condition that affects about 1 to 2% of U.S. adults, with a 5% lifetime risk of esophageal cancer (EAC). High-quality surveillance endoscopies and biopsies can decrease cancer risk; however, overuse of endoscopy and inadequate biopsy sampling is common and may unnecessarily expose patients to procedural risk and increased costs. […] Based on AGA’s Barrett’s esophagus clinical guidance, the AGA quality team has developed two quality measures to guide you in providing high-quality care while minimizing patient risk. […] Providers should adhere to surveillance endoscopy intervals of three to five years for patients with nondysplastic Barrett’s esophagus and avoid inappropriate shorter or longer intervals (i.e., less than three years or greater than five years).

• #16 Barrett’s Oesophagus Information

  https://waitemataendoscopy.co.nz/medical-conditions/barretts-oesophagus

  Barretts oesophagus is the term used for a condition where the normal cells lining the oesophagus (gullet) have been replaced with abnormal cells. The main concern with this condition is that it can increase the risk of developing oesophageal cancer. […] Barretts Oesophagus is thought to occur as a result of a number of years of Gastro-oesophageal reflux. A diagnosis of Barrett’s Oesophagus can only be made with an upper gastrointestinal endoscopy (also known as a Gastroscopy). It is important to diagnose and monitor Barretts oesophagus because there is an increased risk for a patient with this condition to develop oesophageal adenocarcinoma (a specific type of cancer). […] International Medical Societies also recommend that a patient with Barrett’s Oesophagus should undergo a Gastroscopy procedure with biopsies on a regular basis (this is called surveillance). The frequency of Gastroscopy surveillance is determined by the grade of Barrett’s Oesophagus. A patient with intestinal metaplasia without dysplasia will undergo surveillance Gastroscopy approximately every 3-5 years. The frequency for a patient with Low Grade Dysplasia is much higher (every 6-12 months) due to the increased risk for cancer development. A patient with intestinal metaplasia with High Grade Dysplasia may undergo surveillance Gastroscopy every 3 months, or be referred for more definitive therapy immediately.

• #17 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 endoscopic resection as curative treatment for T1a Barrett’s cancer with well/moderate differentiation and no signs of lymphovascular invasion. […] ESGE recommends that the first endoscopic follow-up after successful endoscopic eradication therapy (EET) of BE is performed in an expert center. […] 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. […] 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.

• #18 Barrett’s esophagus: surveillance best practices – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/news/barretts-esophagus-surveillance-best-practices/

  During surveillance upper endoscopy for patients with non-dysplastic Barrett’s esophagus, four-quadrant systematic biopsies should be taken every 1-2 centimeters along the entire length of Barrett’s esophagus. […] Process measure: Percentage of patients with nondysplastic Barrett’s esophagus who undergo surveillance endoscopy in three to five years. […] Process measure: Percentage of patients with nondysplastic Barrett’s esophagus who are evaluated with systematic four-quadrant biopsies every 1-2 cm along the Barrett’s esophagus segment during their surveillance endoscopy. […] Proposed outcome measure: Percentage of patients with Barrett’s esophagus under surveillance who develop EAC.

• #19 New technology and innovation for surveillance and screening in Barrett’s esophagus – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/new-technology-and-innovation-for-surveillance-and-screening-in-barretts-esophagus-be/

  Experts provide 15 best practices on advances and innovation regarding the screening and surveillance of Barrett’s esophagus. […] 1. Screening with standard upper endoscopy may be considered in individuals with at least 3 established risk factors for Barrett’s esophagus (BE) and esophageal adenocarcinoma, including individuals who are male, non-Hispanic white, age >50 years, have a history of smoking, chronic gastroesophageal reflux disease, obesity, or a family history of BE or esophageal adenocarcinoma. […] 2. Nonendoscopic cell-collection devices may be considered as an option to screen for BE. […] 3. Screening and surveillance endoscopic examination should be performed using high-definition white light endoscopy and virtual chromoendoscopy, with endoscopists spending adequate time inspecting the Barrett’s segment.

• #20 New technology and innovation for surveillance and screening in Barrett’s esophagus – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/new-technology-and-innovation-for-surveillance-and-screening-in-barretts-esophagus-be/

  4. Screening and surveillance exams should define the extent of BE using a standardized grading system documenting the circumferential and maximal extent of the columnar lined esophagus (Prague classification) with a clear description of landmarks and the location and characteristics of visible lesions (nodularity, ulceration), when present. […] 5. Advanced imaging technologies such as endomicroscopy may be used as adjunctive techniques to identify dysplasia. […] 6. Sampling during screening and surveillance exams should be performed using the Seattle biopsy protocol (4-quadrant biopsies every 1-2 cm and target biopsies from any visible lesion). […] 7. Wide-area transepithelial sampling may be used as an adjunctive technique to sample the suspected or established Barrett’s segment (in addition to the Seattle biopsy protocol).

• #21 Advanced endoscopic imaging for detection of Barrett’s esophagus

  https://www.e-ce.org/journal/view.php?doi=10.5946/ce.2023.031

  The Seattle protocol is the standard practice for sampling the BE segment to assess for dysplasia. It calls for targeted biopsies of any visible lesions and four random quadrant biopsies every 2 cm for non-dysplastic BE or every 1 cm for dysplastic BE. […] Unfortunately, meta-analyses and cohort studies suggest that a high proportion of BE-related HGD and EAC are missed within the first year following index endoscopy during which the BE diagnosis was made. There are multiple reasons for missed dysplasia and neoplasia, including poor adherence to the Seattle protocol, especially in longer segments of BE. […] The American Society of Gastroenterology (ASGE) released the preservation and incorporation of valuable endoscopic innovations (PIVI) initiative in 2016, a standardized criteria for evaluating the effectiveness of advanced imaging techniques.

• #22 Barrett’s esophagus: A review of diagnostic criteria, clinical surveillance practices and new developments – Booth – Journal of Gastrointestinal Oncology

  https://jgo.amegroups.org/article/view/412/825

  Although there is a lack of randomized trials that support the value of endoscopic surveillance in BE, indirect evidence from multiple retrospective studies indicates a statistically significant improvement in survival for cancers that are detected endoscopically versus those that present with symptoms. […] In light of this evidence and the poor 5 year survival for EAC, surveillance endoscopy is widely practiced. […] If the initial biopsy diagnostic of BE is negative for dysplasia, a repeat endoscopic exam with biopsy is recommended within a year. […] A diagnosis of high grade dysplasia should also be confirmed by an expert pathologist but repeat exam should take place within 3 months. […] Treatment options for high-grade dysplasia include careful surveillance, a variety of ablative therapies, and surgical resection. […] The grading of dysplasia currently guides surveillance and treatment decisions; however it is an imperfect predictor of cancer risk. […] Several biomarkers have shown promise as objective adjunct tests to improve risk stratification of patients with BE.

• #23 Advanced imaging in surveillance of Barrett’s esophagus: Is the juice worth the squeeze?

  https://www.wjgnet.com/1007-9327/full/v25/i25/3108.htm

  Unfortunately, the mortality for esophageal adenocarcinomas is very high, with a mean 5-year survival rate of less than 20% for advanced disease. Many patients are diagnosed at presentation with advanced disease, and there is a need to find better means to identify patients at earlier stages. BE confers a 30-40 fold increased risk for esophageal adenocarcinoma, but it is unclear if such focus on surveillance in BE patients has improved outcomes. Patients with surveillance-detected BE have higher rates of survival at two years compared to patients that are diagnosed outside of a surveillance program (73.3% vs 12.5%, P = 0.02), yet few patients (3.9%) are diagnosed with BE before their cancer diagnosis. In other studies, there was no association between surveillance in BE and decreased risk of death from esophageal adenocarcinoma (OR = 0.99; 95%CI: 0.36-2.75) and the detection of advanced disease was equivalent in surveillance and non-surveillance groups. Therefore, current surveillance strategies may be ineffective in improving patient outcomes.

• #23 Advanced imaging in surveillance of Barrett’s esophagus: Is the juice worth the squeeze?

  https://www.wjgnet.com/1007-9327/full/v25/i25/3108.htm

  Barretts esophagus (BE) is the development of specialized intestinal metaplasia in the esophagus. The exact incidence of BE is not known, but it is estimated to be from 0.2%-2% per year. It is a premalignant lesion for adenocarcinoma of the esophagus. Though the rates of esophageal squamous cell carcinoma and distal gastric cancers are declining, the incidence of esophageal adenocarcinoma is rising more than any other malignancy. Reports have quoted an average annual increase of up to 17%. This increase may be due to environmental and population factors, but also due to insufficient detection of Barretts and insufficient surveillance protocols for patients with known BE. The Seattle protocol guides the surveillance procedure of many endoscopists, which consists of 4-quadrant biopsies at intervals of every 1-2 cm and separate samples of areas of mucosal irregularity, may miss a significant number of areas of low-or high-grade dysplasia. In a large multicenter study, 53% of patients who underwent consecutive surveillance endoscopies documenting non-dysplastic tissue or intestinal metaplasia without dysplasia, developed high grade dysplasia and/or cancer within a mean of 3 years.

• #24 Global burden and epidemiology of Barrett oesophagus and oesophageal cancer | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-021-00419-3

  Patients with EAC who have a prior diagnosis of Barrett oesophagus have better outcomes than patients without a prior diagnosis of Barrett oesophagus; however, this situation represents 10% of patients with EAC. […] Screening for EAC and Barrett oesophagus needs to go beyond patients with frequent gastroesophageal reflux disease symptoms to include other established risk factors, including obesity and smoking. […] To date, no screening or surveillance algorithm has sufficient discriminatory accuracy or external validation to support clinical use. […] Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barretts oesophagus. […] Prior diagnosis of Barretts esophagus is infrequent, but associated with improved esophageal adenocarcinoma survival.

• #25 Current management of Barrett esophagus and esophageal adenocarcinoma | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/86/11/724

  Barrett esophagus is found in 5% to 15% of patients with gastroesophageal reflux disease and is a precursor of esophageal adenocarcinoma, yet the condition often goes undiagnosed. […] Patients with reflux disease who are male, over age 50, or white, and who smoke or have central obesity or a family history of Barrett esophagus or esophageal adenocarcinoma, should undergo initial screening endoscopy and, if no dysplasia is noted, surveillance endoscopy every 3 to 5 years. […] In Barrett esophagus without dysplasia, surveillance endoscopy is recommended every 3 to 5 years to detect dysplasia and early esophageal adenocarcinoma. […] All cases of esophageal adenocarcinoma are thought to arise from Barrett esophagus. […] More than 90% of patients with newly diagnosed esophageal adenocarcinoma do not have a prior diagnosis of Barrett esophagus.

• #26 Optimizing surveillance in patients with dysplastic Barrett esophagus after endoscopic eradication – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/optimizing-surveillance-in-patients-with-dysplastic-barrett-esophagus-after-endoscopic-eradication/mqc-20546598

  Recurrence of intestinal metaplasia and dysplasia after complete endoscopic eradication therapy (EET) of dysplasia or early adenocarcinoma is well documented. Therefore, close surveillance of these patients is necessary. […] Practice guidelines published in 2016 recommended that patients undergo frequent endoscopic surveillance after EET, with those treated for high-grade dysplasia or early cancer requiring surveillance every three months for the first year. Recent registry-based modeling studies, however, have suggested that the intervals between surveillance endoscopies could safely be lengthened. […] Our study showed that if patients with high-grade dysplasia or early esophageal cancer had surveillance every six months in the first two years after disease remission, and annually thereafter, no cases of dysplastic recurrence would go undetected for more than six months.

• #27 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 suggests that, if a patient has reached 75 years of age at the time of the last surveillance endoscopy and/or the patient’s life expectancy is less than 5 years, the discontinuation of further surveillance endoscopies can be considered. […] ESGE recommends offering endoscopic eradication therapy using ablation to patients with BE and low grade dysplasia (LGD) on at least two separate endoscopies, both confirmed by a second experienced pathologist. […] ESGE recommends endoscopic ablation treatment for BE with confirmed high grade dysplasia (HGD) without visible lesions, to prevent progression to invasive cancer. […] ESGE recommends offering complete eradication of all remaining Barrett epithelium by ablation after endoscopic resection of visible abnormalities containing any degree of dysplasia or esophageal adenocarcinoma (EAC).

• #28 Optimal Age to Stop Surveillance of Patients With NDBE Dependent on Sex and General Health – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/news/age-comorbidity-status-important-factors-in-determining-surveillance-discontinuation-in-patients-with-non-dysplastic-barrett-esophagus/

  Investigators aimed to determine the ideal age to discontinue surveillance in patients with non-dysplastic Barrett esophagus based on sex and comorbidities. The optimal age to discontinue surveillance of patients with non-dysplastic Barrett esophagus (NDBE) ranges from 69 to 81 years depending on patients sex and general health, according to a study in Gastroenterology. For men with NDBE and without comorbidities, the researchers found that the optimal age for last surveillance is 81 years, although it may be as many as 8 years earlier for those with comorbidities. For women with NDBE and without comorbidities, the optimal age for last surveillance is 75 years, but it can be up to 6 years earlier for those with comorbidities. Our analysis has important implications for surveillance of NDBE patients, the investigators commented. They concluded, In addition to chronological age, the comorbidity status and sex of patients are important factors to inform the decision to discontinue surveillance.

• #29 When to stop surveillance for non-dysplastic Barrett’s esophagus? – Medical Conferences

  https://conferences.medicom-publishers.com/specialisation/gastroenterology/when-to-stop-surveillance-for-non-dysplastic-barretts-esophagus/

  In the absence of comorbidities, discontinuing endoscopic surveillance of non-dysplastic Barrett’s esophagus (NDBE) in women in their mid-70s and men in their early 80s may be the most cost-effective approach, according to a comparative analysis. Barrett’s esophagus is the only known precursor lesion for esophageal adenocarcinoma. In the U.S., endoscopic eradication therapy is recommended for patients with dysplasia, but endoscopic surveillance is indicated for those with NDBE who are at lower risk. The suggested interval between examinations is from three to five years. However, the authors say, there is no recommendation for the age to discontinue surveillance. Continuation at older ages may not be cost-effective, they observe. The potential harm of endoscopic surveillance, such as complications and false-positive results, in concert with advancing age and lower life expectancy due to comorbidities may increase the cost of the surveillance program considerably. The optimal age to end surveillance was deemed to be that at which the incremental cost-effectiveness ratio of one more surveillance was just below the willingness-to-pay threshold of $100,000 per QALY. In men, surveillance at the age of 68 years was considered cost-effective for all comorbidity levels. An additional surveillance at age 74 for those with severe comorbidities was not cost-effective, and at age 86, one more surveillance was not cost-effective for any level of comorbidity. In men without comorbidities, 81 years was considered the optimal age of last surveillance. The optimal ages of last surveillance were lower in women than in men, at 75 years in those without comorbidities. For women with severe comorbidity, the optimal stopping age was 69 years and for both moderate and severe comorbidities, it was 73 years. The researchers conclude, „In addition to chronological age, the comorbidity status and sex of patients are important factors to inform the decision to discontinue surveillance.”

• #30 Post-ablation surveillance in Barrett’s esophagus: A review of the literature

  https://www.wjgnet.com/1007-9327/full/v22/i17/4297.htm

  Even though most experts agree that surveillance is beneficial following endoscopic treatment of neoplastic BE, there are deficiencies in the current surveillance process that cast doubt on our ability to reliably detect recurrence and progression of disease. […] The adequacy of current surveillance methods has also been called into question on numerous fronts. […] The cost-effectiveness of post-ablation surveillance and new imaging technologies to detect buried intestinal metaplasia are also items gaining attention in the literature, as the financial burden of healthcare continues to grow. […] All of these reasons highlight the need for evidence based protocols to guide surveillance in the post-treatment period.

• #31 New technology and innovation for surveillance and screening in Barrett’s esophagus – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/new-technology-and-innovation-for-surveillance-and-screening-in-barretts-esophagus-be/

  8. Patients with erosive esophagitis should be biopsied when concern of dysplasia or malignancy exists. A repeat endoscopy should be performed after 8 weeks of twice a day proton pump inhibitor therapy. […] 9. Tissue systems pathology-based prediction assay may be utilized for risk stratification of patients with nondysplastic BE. […] 10. Risk stratification models may be utilized to selectively identify individuals at risk for Barrett’s associated neoplasia. […] 11. Given the significant interobserver variability among pathologists, the diagnosis of BE-related neoplasia should be confirmed by an expert pathology review. […] 12. Patients with BE-related neoplasia should be referred to endoscopists with expertise in advanced imaging, resection and ablation. […] 13. All patients with BE should be placed on at least daily proton pump inhibitor therapy.

• #32 Advanced endoscopic imaging for detection of Barrett’s esophagus

  https://www.e-ce.org/journal/view.php?doi=10.5946/ce.2023.031

  The use of advanced imaging technologies aims to better detect dysplastic changes during BE screening and surveillance that may be missed by the Seattle protocol. Early and improved detection of dysplasia allows for treatment modalities to be utilized to achieve complete remission of intestinal metaplasia. Ultimately, with the eradication of the dysplastic BE segment, the incidence of EAC can be reduced. […] The ACG was unable to make formal recommendations regarding the use of WATS-3D in clinical practice. However, in conjunction with FB, WLE, and NBI, WATS-3D may be considered to improve surveillance and detection of BE. […] Early detection of BE-associated dysplasia is essential to prevent progression to EAC. The SSP has its limitations and dysplasia could be missed during esophageal biopsies. Novel developments utilizing enhanced imaging techniques to improve the detection of BE-related dysplastic lesions are being actively studied with promising results. Currently, however, they do not have a definite clinical role due to their limited availability and unclear improvement in diagnostic accuracy compared to the standard of care.

• #33 Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma – Implications for Screening and Surveillance

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7887893/

  Biomarker discovery and validation studies in unselected Barretts esophagus populations using whole esophageal sampling are warranted, and all biomarker studies should strive to be larger and have a strengthened statistical framework. […] Multiple prediction models have been derived for use in selecting high-risk patients for screening and surveillance; however, these models need further validation (temporal and geographic) and optimization before their clinical application can be recommended.

• #34 Monitoring the premalignant potential of Barrett’s oesophagus’ | Frontline Gastroenterology

  https://fg.bmj.com/content/7/4/316

  The BSG guidelines have usefully stratified patients into different risk profiles and suggest altering the frequency of surveillance based on these. Patients with short-segment BE without IM should be discharged after two endoscopies but if IM is present, then 3-5 yearly endoscopy is sufficient. If the segment is more than 3cm long, 2-3 yearly surveillance is recommended. […] The cost-effectiveness of endoscopic screening and surveillance remains controversial with estimates ranging between $10,000 and $100,000 per QALY. Cheaper ways of detecting cancer risk in these patients are clearly needed.

• #35 Barrett’s Esophagus | AAFP

  https://www.aafp.org/pubs/afp/issues/2004/0501/p2113.html

  The question of whom to screen remains. One recent study suggests once-in-a-lifetime endoscopy screening in 50-year-old white men with GERD. […] Once Barretts esophagus is discovered, the question of how to follow affected patients arises. Surveillance of Barretts esophagus is a relatively unproven area of study. As in screening, no evidence has shown that surveillance improves mortality rates. […] Published guidelines for the surveillance of Barretts esophagus suggest different intervals for surveillance endoscopy, depending on histologic findings of previous endoscopy. […] The cost of surveillance has been analyzed. In the United Kingdom, it would cost an estimated $23,000 to detect one case of esophageal cancer in men, compared with $65,000 in women. […] There are several limitations to surveillance in patients with dysplasia. The histologic properties of dysplasia may be difficult to evaluate, because inflamed and healing epithelium may be similar in appearance.

• #36 Barrett Esophagus in Asia: Same Disease with Different Pattern

  https://www.e-ce.org/journal/view.php?number=6602

  Furthermore, a Korean nationwide prospective multicenter study showed that the prevalence of BE remains low in the Korean population. […] In summary, H. pylori infection shows an inverse association with BE. GERD, hiatal hernia, old age, male sex, abdominal obesity (visceral obesity), smoking, and alcohol consumption are risk factors of BE. […] The incidence of EAC has increased significantly in the West. […] Although the incidence of EAC has increased in Asia, these increases have been only slight. […] Monitoring and surveillance data are needed on the general population in Asia. […] Cost-effectiveness studies suggest that BE surveillance was at least as effective as other widely accepted medical practices. […] The cost-effectiveness of endoscopic surveillance of BE was compared with screening mammography in a cohort study. […] Thus, endoscopic surveillance of patients with BE was as cost-effective as surveillance mammography. […] However, it remains to be determined how best to improve the cost-effectiveness of surveillance strategies in patients with BE.

• #37 Barrett’s esophagus: best practices for treatment and post-treatment surveillance – Mansour- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/14105/html

  Surveillance intervals and management options vary according to the presence and grade of dysplasia. For non-dysplastic BE (NDBE), most societal guidelines recommend a repeat surveillance endoscopy in 3-5 years. […] While surveillance of BE appears to be beneficial, the current surveillance strategies are inefficient and include risks of endoscopy and sedation, the possibility of missed lesions, and complications from curative treatment. Therefore, it is important that future research focus on improving the value of BE surveillance by optimizing effectiveness and efficiency. […] Recurrence of BE following CE-IM is not uncommon. A meta-analysis of 41 studies published in 2016 reported that the pooled incidence of BE recurrence (with or without dysplasia/EAC) was 9.5% per patient-year, with rates in individual studies ranging from 0.9% to 28.8%. […] Therefore, continued endoscopic surveillance after treatment is essential. The intervals and biopsy protocols for post-treatment surveillance are based on expert opinion due to a lack of adequate evidence on which to base recommendations.

• #38 Barrett’s esophagus: Surveillance and management – UpToDate

  https://www.uptodate.com/contents/barretts-esophagus-surveillance-and-management

  The risk of developing cancer is higher among males, older patients, patients with long segments of Barrett’s mucosa, and patients with a family history of Barrett’s esophagus or esophageal adenocarcinoma. […] Patients with Barrett’s esophagus most often die from causes unrelated to esophageal cancer.

• #39 Monitoring the premalignant potential of Barrett’s oesophagus’ | Frontline Gastroenterology

  https://fg.bmj.com/content/7/4/316

  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. […] The incidence of oesophageal adenocarcinoma has been rising over the past 40 years such that oesophageal cancer is now the fourth most common cause of cancer death in men in the UK. Barrett’s oesophagus (BE) is the only identifiable premalignant condition for oesophageal adenocarcinoma. Interventions are focused on reducing the risk of progressing from BE to oesophageal adenocarcinoma. […] NICE recommends considering surveillance to check for progression to cancer for people who already have a diagnosis of BE confirmed by endoscopy and histopathology, having taken into account the patient’s preferences and risk factors. An important caveat is that the harms of endoscopic surveillance may outweigh the benefits particularly in patients at low risk of progression to cancer, such as those with stable non-dysplastic BE.

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