TY - JOUR
T1 - Emerging Concepts for the Endoscopic Management of Superficial Esophageal Adenocarcinoma
AU - Greene, Christina L.
AU - Worrell, Stephanie G.
AU - Attwood, Stephen E.
AU - Chandrasoma, Parakrama
AU - Chang, Kenneth
AU - DeMeester, Tom R.
AU - Lord, Reginald V.
AU - Montgomery, Elizabeth
AU - Pech, Oliver
AU - Vallone, John
AU - Vieth, Michael
AU - Wang, Kenneth K.
AU - DeMeester, Steven R.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Introduction: Endoscopic therapy has revolutionized the treatment of Barrett’s esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma. Methods: A small group colloquium consisting of gastroenterologists, surgeons, and pathologists reviewed published data and discussed personal and institutional experiences with endotherapy for HGD and superficial esophageal adenocarcinoma. Results: The group reviewed data and provided recommendations and management algorithms for seven areas pertaining to endoscopic therapy for Barrett’s HGD and superficial adenocarcinoma: (1) patient selection and evaluation; (2) imaging and biopsy techniques; (3) devices; (4) indications for resection versus ablation; (5) ER specimen handling, processing, and pathologic evaluation; (6) patient care and follow-up after endoscopic therapy; and (7) complications of endoscopic therapy and treatment options. Conclusions: Endoscopic therapy is preferred over esophagectomy for most patients with HGD or intramucosal adenocarcinoma, and may be applicable to select patients with submucosal tumors. Clear guidelines and management algorithms will aid physicians and centers embarking on endoscopic therapy and enable a standardized approach to the management of these patients that is applicable internationally.
AB - Introduction: Endoscopic therapy has revolutionized the treatment of Barrett’s esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma. Methods: A small group colloquium consisting of gastroenterologists, surgeons, and pathologists reviewed published data and discussed personal and institutional experiences with endotherapy for HGD and superficial esophageal adenocarcinoma. Results: The group reviewed data and provided recommendations and management algorithms for seven areas pertaining to endoscopic therapy for Barrett’s HGD and superficial adenocarcinoma: (1) patient selection and evaluation; (2) imaging and biopsy techniques; (3) devices; (4) indications for resection versus ablation; (5) ER specimen handling, processing, and pathologic evaluation; (6) patient care and follow-up after endoscopic therapy; and (7) complications of endoscopic therapy and treatment options. Conclusions: Endoscopic therapy is preferred over esophagectomy for most patients with HGD or intramucosal adenocarcinoma, and may be applicable to select patients with submucosal tumors. Clear guidelines and management algorithms will aid physicians and centers embarking on endoscopic therapy and enable a standardized approach to the management of these patients that is applicable internationally.
KW - Endoscopic resection
KW - Endotherapy
KW - Esophageal adenocarcinoma
KW - Esophagectomy
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U2 - 10.1007/s11605-015-3056-0
DO - 10.1007/s11605-015-3056-0
M3 - Article
C2 - 26691147
AN - SCOPUS:84961778301
SN - 1091-255X
VL - 20
SP - 851
EP - 860
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 4
ER -