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Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
Barrett’s esophagus is a precancerous condition characterized by abnormal replacement of the squamous epithelium of the lower esophagus by a columnar-type epithelium resembling that in the stomach and intestine. Barrett’s esophagus may progress through a series of cellular changes of metaplasia, dysplasia, and neoplasia cumulating in esophageal AC. The intermediate stages of dysplasia can be graded into low-grade and high-grade dysplasia according to the degree of abnormal cellular architecture.
Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Barrett’s esophagus is present when the normal distal esophageal squamous mucosa is replaced by a metaplastic columnar mucosa containing goblet cells (intestinal metaplasia). This is visible at esophagoscopy by the characteristic “salmon-pink” appearance and confirmed by mucosal biopsy. It is identified at endoscopy performed to investigate suspected gastroesophageal reflux symptoms in approximately 10% of individuals and is present in 1–2% of all adults in many Western countries. Barrett’s esophagus is a significant issue as it is the only known precursor to esophageal adenocarcinoma. Esophageal cancer can be of two subtypes (squamous and adenocarcinoma), with squamous cell cancer more common in Asia and many parts of the world. Esophageal adenocarcinoma is an increasingly important problem, mainly in Western developed countries, where its incidence has increased more than six-fold over the last four decades. It now accounts for 70–80% of esophageal cancers diagnosed in Australia, UK, and the United States. Barrett’s esophagus is the identifiable intermediate step in the development of esophageal adenocarcinoma.
The Esophagus
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Another acquired condition is Barrett’s esophagus which is a condition in which the lower esophagus is lined by columnar epithelium which has replaced the squamous lining. Such a condition is presumed to be due to acid reflux. Chronic gastroesophageal reflux can cause severe inflammation and injury to the squamous epithelial lining of the esophagus, which is replaced by the columnar epithelium presumably from the stomach, which has a higher healing rate than the squamous type. Several centers have been reporting a higher incidence of adenocarcinoma of the lower esophagus in such patients. Actually, some centers are reporting 14 to 20% adenocarcinoma of the lower esophagus in association with Barrett’s.
“Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery”
Published in Annals of Medicine, 2023
Cem Kaan Parsak, İlker Halvacı, Uğur Topal
The prevalence of the endoscopic detection of esophagitis in symptomatic patients is 20% – approximately 100 times higher than in the normal population [2]. The most concerning complication is Barrett’s esophagus, Barrett’s esophagus among individuals with gastro-oesophageal reflux varied according to different geographical regions ranging from 3% to 14% for histologically confirmed Barrett’s esophagus with a pooled prevalence of 7.2% (95% CI 5.4%–9.3%) Estimates of the annual cancer incidence in patients with Barrett’s esophagus have ranged from 0.1 to 0,4 percent. 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 [3,4].
Cost-effectiveness of a novel, non-active implantable device as a treatment for refractory gastro-esophageal reflux disease
Published in Journal of Medical Economics, 2023
Sam Harper, Lukasz Grodzicki, Stuart Mealing, Liz Gemmill, Paul J. Goldsmith, Ahmed R. Ahmed
Health Related Quality-of-Life (HRQoL) was described using utility decrements. The utility decrements for those who have had a successful surgery was based on the proportion reporting persistent dysphagia, a potential ongoing adverse effect of surgery. A utility decrement of 0.24 was applied for 1 month following all initial surgical procedures and reoperations (in all model arms), and was based on the quality-of-life impact of undergoing a laparoscopic cholecystectomy15 which represents a conservative approach, since laparoscopic cholecystectomy is a more complex procedure compared with GERD surgery. Utility decrements in patients receiving PPIs were based on a cost-effectiveness analysis of PPIs and laparoscopic Nissen fundoplication in the treatment of GERD based on the REFLUX trial, a large UK-based trial funded by the NHS15,18. Another analysis based on this trial informed the utility decrement associated with unsuccessful Nielsen fundoplication surgery, which was assumed to also apply to MSA and RefluxStop18. Patients with Barrett’s esophagus and esophageal cancer also experienced utility decrements associated with these conditions. All HRQoL model inputs are listed in Table 1.
Effectiveness of esophagogastroduodenoscopy in changing treatment outcome in refractory gastro-esophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2022
Ye Eun Kwak, Ahmed Saleh, Ahmed Abdelwahed, Mayra Sanchez, Amir Masoud
Screening EGD for Barrett's esophagus or esophageal adenocarcinoma based on GERD symptoms is neither sensitive nor specific [5,6]. Many patients develop Barrett’s esophagus without reflux symptoms, and the prevalence of Barrett’s esophagus is similar in patients with or without reflux symptoms [7–9]. Most studies used questionnaires focusing mainly on reflux symptoms, but have not excluded patients with other concurrent symptoms that may increase the prevalence of Barrett's esophagus or esophageal adenocarcinoma. Furthermore, efforts to develop prediction models for Barrett’s esophagus using GERD symptoms and risk factors such as elderly age, male gender or Caucasian ethnicity only showed modest accuracy [5,10,11], and this makes reflux symptom-based screening EGD strategy more controversial.