Japan Digestive Disease Week 2022
Invited Lecture (JGES)
October 29, 9:00–9:30, Room 9 (Fukuoka International Congress Center 413+414)
Invited Lecture-9
New development in management of Barrett neoplasia
- Department of Gastroenterology, University Hospital Augsburg
Barrett cancer (BC) is still a rare form of cancer in the western world, however, BC is the cancer with the fastest rise in incidence rates in the last 10 years.
Upper GI-screening is not generally recommended; however, patients with specific risk factors such as reflux disease, obesity, age above 50 years and male gender should undergo a screening gastroscopy.
On the other hand, surveillance in patients with Barrett´s esophagus is recommended with the aim of detecting early stage dysplastic or neoplastic lesions.
High-definition endoscopy including virtual chromoendoscopy are helpful tools, and especially the combination of NBI with acetic acid has shown benefits in the detection of dysplasia.
Nevertheless, the characterization of Barrett´s mucosa (dysplastic cs. non-dysplastic) remains a challenge. With the new BING classification, experts were able to discriminate neoplastic from non-neoplastic Barrett with a sensitivity and specificity of more than 90%.
Artificial intelligence (AI) might be helpful for this task as well. Similar to colonoscopy, this technique may also improve the management of Barrett´s esophagus. Our group was the first worldwide to demonstrate the utility and potential of AI and deep learning in the detection and differentiation of neoplastic lesions in Barrett´s esophagus. In the meantime, we have published pioneer data on the differentiation of mucosal and submucosal BC with AI.
The endoscopic treatment of early Barrett neoplasia should be performed in specialized centres where all diagnostic and therapeutic options are available.
Barrett´s esophagus without dysplasia needs no specialized endoscopic therapy.
In special situations, where dysplastic areas within a Barrett´s esophagus are non-visible, ablation therapy is recommended. Surveillance may be an option only for low grade dysplasia; however, ablation therapy could reduce the number of invasive cancers or the progress of dysplasia in this situation.
After endoscopic resection of neoplastic lesions, the remaining Barrett´s mucosa must be ablated to reduce the risk of metachronous neoplasia; in this situation regular surveillance endoscopies are recommended.
So far, ablation with radiofrequency (RFA) seems to be the treatment of choice; however, cryotherapy and (hybrid-) APC seem to be as effective as RFA with less pain, especially for cryotherapy.
A matter of debate is the resection technique: EMR or ESD? The ESGE Guideline recommends EMR for lesions smaller than 15 mm. However, if the lesions are larger or suspicious of sm-invasion, with poor lifting, ESD is the recommended treatment of choice.
Upper GI-screening is not generally recommended; however, patients with specific risk factors such as reflux disease, obesity, age above 50 years and male gender should undergo a screening gastroscopy.
On the other hand, surveillance in patients with Barrett´s esophagus is recommended with the aim of detecting early stage dysplastic or neoplastic lesions.
High-definition endoscopy including virtual chromoendoscopy are helpful tools, and especially the combination of NBI with acetic acid has shown benefits in the detection of dysplasia.
Nevertheless, the characterization of Barrett´s mucosa (dysplastic cs. non-dysplastic) remains a challenge. With the new BING classification, experts were able to discriminate neoplastic from non-neoplastic Barrett with a sensitivity and specificity of more than 90%.
Artificial intelligence (AI) might be helpful for this task as well. Similar to colonoscopy, this technique may also improve the management of Barrett´s esophagus. Our group was the first worldwide to demonstrate the utility and potential of AI and deep learning in the detection and differentiation of neoplastic lesions in Barrett´s esophagus. In the meantime, we have published pioneer data on the differentiation of mucosal and submucosal BC with AI.
The endoscopic treatment of early Barrett neoplasia should be performed in specialized centres where all diagnostic and therapeutic options are available.
Barrett´s esophagus without dysplasia needs no specialized endoscopic therapy.
In special situations, where dysplastic areas within a Barrett´s esophagus are non-visible, ablation therapy is recommended. Surveillance may be an option only for low grade dysplasia; however, ablation therapy could reduce the number of invasive cancers or the progress of dysplasia in this situation.
After endoscopic resection of neoplastic lesions, the remaining Barrett´s mucosa must be ablated to reduce the risk of metachronous neoplasia; in this situation regular surveillance endoscopies are recommended.
So far, ablation with radiofrequency (RFA) seems to be the treatment of choice; however, cryotherapy and (hybrid-) APC seem to be as effective as RFA with less pain, especially for cryotherapy.
A matter of debate is the resection technique: EMR or ESD? The ESGE Guideline recommends EMR for lesions smaller than 15 mm. However, if the lesions are larger or suspicious of sm-invasion, with poor lifting, ESD is the recommended treatment of choice.