Screening and testing of Barrett's esophagus, one article contains the latest points

It is only for medical professionals to read and reference.
All are dry goods ~ 22: 00-23: 30 pm on May 21, 2021, Beijing time, the United States Disease Week (DDW) held a theme meeting on the current management of Barrett's esophagus.

This conference was hosted by Professor Prateek Sharma, and scholars shared their clinical experience in Barrett's esophagus screening, monitoring and risk stratification management.

Barrett's esophagus: Controversy and progress in screening Barrett's esophagus is a pathological phenomenon in which the stratified squamous epithelium of the lower esophageal mucosa is replaced by a single columnar epithelium.
It is the only known esophageal adenocarcinoma (EAC) Precancerous lesions.

The process is roughly: esophageal reflux → Barrrett's esophagus → dysplasia → intramucosal carcinoma → esophageal invasive adenocarcinoma.

Barrett's esophagus monitoring and early detection and treatment can prevent the development of EAC.

Professor Vani J.
Konda pointed out that the current screening model for Barrett's esophagus is still incomplete.
Among patients undergoing surgical treatment for esophageal cancer, only about 5% of patients have been diagnosed with Barrett's esophagus.

Regarding how to screen Barrett's esophagus, Professor Vani J.
Konda recommends the use of endoscopy to screen Barrett's esophagus in people with a history of chronic reflux disease and a variety of risk factors, including: a family history of Barrett's esophagus or EAC, age >50 Years old, male, white, obese, smoking, hiatal hernia.

Secondly, put forward 5L's recommendations for high-quality endoscopic evaluation, namely "Landmarks": identify and record important esophageal markings under endoscopy, such as diaphragmatic pressure, gastric fold top and the junction of squamous and columnar epithelium; "Length" : Measure and mark the length of Barrett's esophagus, the length and severity of esophagitis; "Look": Check and evaluate subtle lesions, consider using high-resolution endoscopes, soft distal attachment caps, pigmented endoscopy and virtual pigmented endoscopy Auxiliary examinations such as mirrors; "Lesions": four-quadrant histological biopsy, emphasizing the avoidance of unnecessary Z-line biopsy; "Levels": assessing whether there is dysplasia.

Finally, Professor Vani J.
Konda introduced to us the technique of Wide Area Transepithelial Sampling (WATS), which can be used as an auxiliary histological sampling to improve the diagnosis of Barrett's esophagus and dysplasia based on the standard four-quadrant biopsy protocol.

In addition, advances in non-sedative screening technologies, such as transnasal endoscopy, tethered volume endoscopy, cell collection devices combined with biomarker analysis, and new breath sampling of volatile organic compounds, may be screened The screening is transferred to an office-based environment and is applicable to a wider range of screening populations.

Imaging technology in Barrett's esophagus monitoring: What should we use? Next, Dr.
Nicholas J.
Shaheen of the University of North Carolina School of Medicine shared his understanding and suggestions on the imaging technology in Barrett's esophagus monitoring.

First of all, during Barrett's esophageal monitoring, Dr.
Nicholas J.
Shaheen believes that it is necessary for endoscopists to further improve their ability to correctly identify and locate neoplastic lesions (high-grade dysplasia and EAC) through training.

Most of the cross-sectional research data from tertiary medical institutions support auxiliary imaging methods to help improve the sensitivity and specificity of histological diagnosis.

Dr.
Nicholas J.
Shaheen suggested that high-resolution white light endoscopy combined with narrow-band imaging endoscopy is still the conventional imaging mode for Barrett's esophagus monitoring.

The role of artificial intelligence-assisted replacement of endoscopists in Barrett's esophagus detection remains to be further studied.

The risk stratification and management of Barrett's esophagus with dysplasia, Professor Marcia lrene from the Center for Gastroenterology, Johns Hopkins University, introduced us to the risk stratification and management of Barrett's esophagus with dysplasia.

At present, there are tiered management recommendations for Barrett's esophagus with dysplasia.
Endoscopic mucosal resection is the first choice for Barrett's esophagus with high-grade dysplasia.
Radiofrequency ablation can be used for flat mucosal lesions until complete remission.
For Barrett's esophagus with low-grade dysplasia, it is recommended to White-light endoscopic monitoring is performed for 3-6 months, and radiofrequency ablation is feasible for diagnosed and long-term low-grade dysplasia.

Professor Marcia Lrene suggested further distinguishing high-risk patients at risk of tumor progression for endoscopic eradication therapy.

Professor Marcia Lrene then introduced the clinicopathological factors related to the progression of Barrett's esophageal tumors, including gender (male), long Barrett's esophagus, smoking, and low-grade/high-grade dysplasia.

She proposed that molecular biomarkers can also be used to predict tumor progression, including p53 expression, DNA aneuploidy, somatic mutation burden, and epigenetic changes.

Among them, abnormal p53 overexpression is an effective marker for dysplasia.
It has been confirmed in a number of large case-control and prospective studies that it can be used to predict tumor progression in Barrett's esophagus, with a sensitivity of 64%, a specificity of 92%, and a positive prediction.
The value is 54%, and the negative predictive value is 95%.

A multicenter prospective cohort study evaluated nine tissue biomarkers (expression of p53 and cyclina; DNA aneuploidy and tetraploid; CDKN2A (p16), RUNX3 and HPP1 hypermethylation; 9p and 17p heterozygous Absence of sex) predicts the tumor progression of Barrett's esophagus.
The results show that immunohistochemical aneuploidy and abnormal expression of p53 are the only biomarkers shown to be related to the progression of Barrett's esophagus, and DNA aneuploidy is the only predictive function.
Barrett's esophagus with dysplasia progresses to a biomarker of high-grade dysplasia or EAC significant ability.

The predictive power of DNA aneuploidy with or without p53 expression model is significantly better than the clinical model based on age and Barrett's esophageal length, suggesting that molecular biomarkers can be used in clinical practice to guide the risk stratification of Barrett's esophageal tumor progression .

Finally, Professor Marcia Lrene proposed that dysplasia is still the most valuable predictor of the progression of Barrett's esophageal tumors, but the research to identify biomarkers that can predict the progression of Barrett's esophageal tumors is useful for guiding clinical decision-making (including the interval between endoscopic monitoring).
And the timing of endoscopic treatment) will be very useful.

Through the sharing of this meeting, clinicians can understand the controversy and progress in the current management of Barrett's esophagus.
New technical methods and concepts based on molecular detection methods are hopeful to identify those who have progressed to cancer or have a high risk of progressing to cancer.
Patients with Barrett's esophagus may become the key to clinical management of Barrett's esophagus.

 Expert profile Wu Junchao, chief physician of the Department of Gastroenterology, West China Hospital, Sichuan University, graduated from the West China Medical University School of Clinical Medicine and has been working in the school until now.
He is mainly engaged in the diagnosis and treatment of the digestive system and digestive endoscopy, especially the diagnosis and treatment of early gastrointestinal cancer.
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