Barrett Esophagus: Improving Surveillance Strategies
The aim of surveillance in patients with a Barrett esophagus (BE) is to detect progression of dysplasia at an early and therefore likely curable stage. The interval of endoscopic surveillance in patients with BE is currently based on the histopathological stage (i.e. grade of dysplasia). This approach is however known to have several pitfalls. First, only patients with intestinal metaplasia (IM) in the columnar-lined segment of the esophagus (CLE) have so far been regarded to have a premalignant condition and are enrolled in an endoscopic surveillance program, in contrast to patients with only cardiac-type mucosa (CM) in their biopsies. However, as IM and CM can be both present in the CLE and are endoscopically indiscernible, sampling error can occur, and exclusion of patients with only CM from endoscopic follow-up might therefore be incorrect. In addition, it has been suggested that IM in CLE may develop over time, and a follow-up endoscopy in the course of time may than detect IM. Secondly, in line with the risk of neoplastic progression, the presence or absence of dysplasia in IM determines the frequency of endoscopic surveillance, but the interpretation of dysplasia is subject to considerable interobserver variability, leading to both superfl uous follow-up endoscopies in some patients and insuffi cient control of others. Therefore, it is relevant to perform risk stratifi cation to defi ne which subgroup of patients with CLE with or without IM should undergo endoscopic follow-up, and at which frequency. The aim of the work described in this thesis was to assess the currently used criteria for performing endoscopic surveillance in patients with CLE, and to evaluate which clinical characteristics and biomarkers could contribute to risk stratifi cation in patients with CLE, in order to refi ne surveillance strategies in these patients.
|Keywords||Barrett Esophagus, gastroenterology, neoplastic processes|
|Promotor||E.J. Kuipers (Ernst)|
|Publisher||Erasmus University Rotterdam|
|Sponsor||Altana Pharma B.V., AstraZeneca B.V., Janssen-Cilag B.V., Pentax Nederland B.V., Schering-Plough B.V., Department of Gastroenterology and Hepatology, Erasmus MC Rotterdam|
Kerkhof, M.. (2007, June 14). Barrett Esophagus: Improving Surveillance Strategies. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/13304