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Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrett's esophagus: a multicenter randomized study.
van Munster, Sanne N; Leclercq, Philippe; Haidry, Rehan; Messmann, Helmut; Probst, Andreas; Ragunath, Krish; Bhandari, Pradeep; Repici, Alessandro; Munoz-Navas, Miguel; Seewald, Stefan; Lemmers, Arnaud; Fernández-Esparrach, Glòria; Pech, Oliver; Schoon, Erik J; Kariv, Revital; Neuhaus, Horst; Weusten, Bas L A M; Siersema, Peter D; Correale, Loredana; Meijer, Sybren L; de Hertogh, Gert; Bergman, Jacques J G H M; Hassan, Cesare; Bisschops, Raf.
Afiliación
  • van Munster SN; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
  • Leclercq P; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • Haidry R; Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
  • Messmann H; Department of Gastroenterology and Hepatology, University Hospital London, London, UK.
  • Probst A; Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany.
  • Ragunath K; Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany.
  • Bhandari P; Department of Gastroenterology and Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
  • Repici A; Department of Gastroenterology and Hepatology, Queen Alexandra Hospital Solent Centre for Digestive Diseases, Portsmouth, UK.
  • Munoz-Navas M; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
  • Seewald S; Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.
  • Lemmers A; Department of Gastroenterology, University of Navarra Clinic. Pamplona, Spain.
  • Fernández-Esparrach G; Department of Gastroenterology and Hepatology, Hirslanden Private Clinic Group, Zurich, Switzerland.
  • Pech O; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
  • Schoon EJ; Endoscopy Unit, Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
  • Kariv R; Department of Gastroenterology and Hepatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany.
  • Neuhaus H; Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands.
  • Weusten BLAM; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
  • Siersema PD; Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
  • Correale L; Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany.
  • Meijer SL; Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
  • de Hertogh G; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • Bergman JJGHM; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Hassan C; Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy.
  • Bisschops R; Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Endoscopy ; 55(4): 303-310, 2023 04.
Article en En | MEDLINE | ID: mdl-36150646
BACKGROUND: Current surveillance for Barrett's esophagus (BE), consisting of four-quadrant random forceps biopsies (FBs), has an inherent risk of sampling error. Wide-area transepithelial sampling (WATS) may increase detection of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). In this multicenter randomized trial, we aimed to evaluate WATS as a substitute for FB. METHODS: Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice versa. All WATS samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Diagnostics laboratory. Similarly, all FBs were examined by two expert pathologists. The primary end point was concordance/discordance for detection of HGD/EAC between the two techniques. RESULTS: 172 patients were included, of whom 21 had HGD/EAC detected by both modalities, 18 had HGD/EAC detected by WATS but missed by FB, and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (P = 0.36). Using WATS as an adjunct to FB significantly increased the detection of HGD/EAC vs. FB alone (absolute increase 10 % [95 %CI 6 % to 16 %]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95 %CI 5.9 to 7.1), 4.9 (95 %CI 4.1 to 5.4), and 11.2 (95 %CI 10.5 to 14.0), respectively. CONCLUSIONS: Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for the detection of HGD/EAC as single modality.
Asunto(s)

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Lesiones Precancerosas / Esófago de Barrett / Neoplasias Esofágicas / Adenocarcinoma Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Revista: Endoscopy Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Lesiones Precancerosas / Esófago de Barrett / Neoplasias Esofágicas / Adenocarcinoma Tipo de estudio: Clinical_trials Límite: Humans Idioma: En Revista: Endoscopy Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos