RESUMO
BACKGROUND: Computer-aided detection (CADe) systems could assist endoscopists in detecting early neoplasia in Barrett's oesophagus, which could be difficult to detect in endoscopic images. The aim of this study was to develop, test, and benchmark a CADe system for early neoplasia in Barrett's oesophagus. METHODS: The CADe system was first pretrained with ImageNet followed by domain-specific pretraining with GastroNet. We trained the CADe system on a dataset of 14â046 images (2506 patients) of confirmed Barrett's oesophagus neoplasia and non-dysplastic Barrett's oesophagus from 15 centres. Neoplasia was delineated by 14 Barrett's oesophagus experts for all datasets. We tested the performance of the CADe system on two independent test sets. The all-comers test set comprised 327 (73 patients) non-dysplastic Barrett's oesophagus images, 82 (46 patients) neoplastic images, 180 (66 of the same patients) non-dysplastic Barrett's oesophagus videos, and 71 (45 of the same patients) neoplastic videos. The benchmarking test set comprised 100 (50 patients) neoplastic images, 300 (125 patients) non-dysplastic images, 47 (47 of the same patients) neoplastic videos, and 141 (82 of the same patients) non-dysplastic videos, and was enriched with subtle neoplasia cases. The benchmarking test set was evaluated by 112 endoscopists from six countries (first without CADe and, after 6 weeks, with CADe) and by 28 external international Barrett's oesophagus experts. The primary outcome was the sensitivity of Barrett's neoplasia detection by general endoscopists without CADe assistance versus with CADe assistance on the benchmarking test set. We compared sensitivity using a mixed-effects logistic regression model with conditional odds ratios (ORs; likelihood profile 95% CIs). FINDINGS: Sensitivity for neoplasia detection among endoscopists increased from 74% to 88% with CADe assistance (OR 2·04; 95% CI 1·73-2·42; p<0·0001 for images and from 67% to 79% [2·35; 1·90-2·94; p<0·0001] for video) without compromising specificity (from 89% to 90% [1·07; 0·96-1·19; p=0·20] for images and from 96% to 94% [0·94; 0·79-1·11; ] for video; p=0·46). In the all-comers test set, CADe detected neoplastic lesions in 95% (88-98) of images and 97% (90-99) of videos. In the benchmarking test set, the CADe system was superior to endoscopists in detecting neoplasia (90% vs 74% [OR 3·75; 95% CI 1·93-8·05; p=0·0002] for images and 91% vs 67% [11·68; 3·85-47·53; p<0·0001] for video) and non-inferior to Barrett's oesophagus experts (90% vs 87% [OR 1·74; 95% CI 0·83-3·65] for images and 91% vs 86% [2·94; 0·99-11·40] for video). INTERPRETATION: CADe outperformed endoscopists in detecting Barrett's oesophagus neoplasia and, when used as an assistive tool, it improved their detection rate. CADe detected virtually all neoplasia in a test set of consecutive cases. FUNDING: Olympus.
Assuntos
Esôfago de Barrett , Aprendizado Profundo , Neoplasias Esofágicas , Humanos , Esôfago de Barrett/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Esofagoscopia/métodos , Razão de ChancesRESUMO
Rectal bleeding is a frequent symptom in proctology. In most cases frequent causes, such as anal fissures and hemorrhoidal disease can be diagnosed and treated using a structured patient history and basic proctological diagnostic assessment; however, it is not uncommon for proctitis to be the reason for rectal bleeding, which necessitates interdisciplinary diagnostics and treatment. In addition to proctitis associated with chronic inflammatory bowel disease, prolapse-induced, radiogenic, ischemic, infectious types and proctitis associated with sexually transmitted diseases represent important differential diagnoses. Moreover, rectal cancer has to be excluded as the cause of rectal bleeding. Finally, with appropriate diligence most causes of rectal bleeding can be securely identified and effectively managed; however, special circumstances can necessitate interdisciplinary diagnostics and management, including conservative, topical, interventional and surgical treatment options.
Assuntos
Cirurgia Colorretal , Fissura Anal , Hemorragia Gastrointestinal , Hemorroidas , Hemorragia Gastrointestinal/terapia , Hemorroidas/complicações , Humanos , RetoRESUMO
BACKGROUND & AIMS: Endoscopic detection of early Barrett's esophagus-related neoplasia (BORN) is a challenge. We aimed to develop a web-based teaching tool for improving detection and delineation of BORN. METHODS: We made high-definition digital videos during endoscopies of patients with BORN and non-dysplastic Barrett's esophagus. Three experts superimposed their delineations of BORN lesions on the videos using special tools. In phase one, 68 general endoscopists from 4 countries assessed 4 batches of 20 videos. After each batch, mandatory feedback compared the assessors' interpretations with those from experts. These data informed the selection of 25 videos for the phase 2 module, which was completed by 121 new assessors from 5 countries. A 5-video test batch was completed before and after scoring of the four 5-video training batches. Mandatory feedback was as in phase 1. Outcome measures were scores for detection, delineation, agreement delineation, and relative delineation of BORN. RESULTS: A linear mixed-effect model showed significant sequential improvement for all 4 outcomes over successive training batches in both phases. In phase 2, median detection rates of BORN in the test batch increased by 30% (P < .001) after training. From baseline to the end of the study, there were relative increases in scores of 46% for detection, 129% for delineation, 105% for agreement delineation, and 106% for relative delineation (all, P < .001). Scores improved independent of assessors' country of origin or level of endoscopic experience. CONCLUSIONS: We developed a web-based teaching tool for endoscopic recognition of BORN that is easily accessible, efficient, and increases detection and delineation of neoplastic lesions. Widespread use of this tool might improve management of Barrett's esophagus by general endoscopists.
Assuntos
Esôfago de Barrett/patologia , Instrução por Computador/métodos , Educação Médica Continuada/métodos , Educação de Pós-Graduação em Medicina/métodos , Neoplasias Esofágicas/patologia , Esofagoscopia/educação , Esôfago/patologia , Internet , Biópsia , Canadá , Transformação Celular Neoplásica/patologia , Competência Clínica , Europa (Continente) , Retroalimentação , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estados Unidos , Gravação em VídeoRESUMO
The rate of lymph-node (LN) metastasis in early adenocarcinoma (EAC) of the esophagus with mid to deep submucosal invasion (pT1b sm2/3) has not yet been precisely defined. The aim of the this study was to evaluate the rate of LN metastasis in pT1b sm2/3 EAC depending on macroscopic and histological risk patterns to find out whether there may also be options for endoscopic therapy as in cancers limited to the mucosa and the upper third of the submucosa. A total of 1.718 pt with suspicion of EAC were referred for endoscopic treatment (ET) to the Dept. of Internal Medicine II at HSK Wiesbaden 1996-2010. In 230/1.718 pt, the suspicion (endoscopic ultrasound, EUS) or definitive diagnosis of pT1b EAC (ER/surgery) was made. Of these, 38 pt had sm2 lesions, and 69 sm3. Rate of LN metastasis was analyzed depending on risk patterns: histologically low-risk (hisLR): G1-2, L0, V0; histologically high-risk (hisHR): ≥1 criterion not fulfilled; macroscopically low-risk (macLR): gross tumor type I-II, tumor size ≤2 cm; macroscopically high-risk (macHR): ≥1 criterion not fulfilled; combined low-risk (combLR): hisLR+macLR; combined high-risk (combHR): at least 1 risk factor. LN rate was only evaluated in pt who had proven maximum invasion depth of sm2/sm3, and who in case of ET had a follow-up (FU) by EUS of at least 24 months. 23/38 pt with pT1b sm2 lesions and 39/69 pt with sm3 lesions fulfilled our inclusion criteria. In the pT1b sm2 group, rate of LN metastasis in the hisLR, hisHR, combLR, and combHR groups were 8.3% (1/12), 36.3% (4/11), 0% (0/5), and 27.8% (5/18). In the pT1b sm3 group, rate of LN metastasis in the hisLR, hisHR, combLR and combHR groups were 28.6% (2/7), 37.5% (12/32), 25% (1/4), and 37.1% (13/35). 30-day mortality of surgery was 1.7% (1/58 pt). In EAC with pT1b sm2/3 invasion, the frequency of LN metastasis depends on macroscopic and histological risk patterns. Surgery remains the standard treatment, because the rate of LN metastasis appears to be higher than the mortality risk of surgery. Whether a highly selected group of pT1b sm2 patients with a favourable risk pattern may be candidates for endoscopic therapy cannot be decided until the results of larger case volumes are available.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Endossonografia/métodos , Mucosa Esofágica/patologia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Linfonodos/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/métodos , Mucosa Esofágica/diagnóstico por imagem , Mucosa Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Esofagoscopia/métodos , Esôfago/patologia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Carga TumoralRESUMO
Gastroesophageal reflux disease (GERD) is highly prevalent in the Western world. Patients with GERD have a 10-fold increased risk to develop a Barrett's esophagus. Patients with Barrett's esophagus have a higher risk for an esophageal adenocarcinoma. Men have more severe reflux with a higher grade of inflammation and acid reflux. This seems to be the reason why men develop a Barrett's esophagus more frequently - the risk is approximately 2-3-fold and the risk for an esophageal adenocarcinoma is even 3-6 times higher.
Assuntos
Adenocarcinoma/etiologia , Esôfago de Barrett/epidemiologia , Neoplasias Esofágicas/etiologia , Refluxo Gastroesofágico , Esôfago de Barrett/complicações , Progressão da Doença , Feminino , Humanos , Masculino , Fatores de RiscoRESUMO
Differential diagnostic aspects of colon stenoses are discussed using the example case of a female patient presenting with multilocular colon metastases, who had lobular breast cancer 9 years previously. Typical is linitis plastica, which can indicate tumorous infiltration not only of the stomach, but also of the large intestine. Other endoscopic imaging and histological studies may, however, fail. The pathologist requires the anamnestic data relating to the breast cancer for exact assignment of the tumorous infiltration.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/secundário , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/prevenção & controle , Idoso , Antineoplásicos/administração & dosagem , Neoplasias da Mama/terapia , Neoplasias do Colo/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Letrozol , Invasividade Neoplásica , Nitrilas/administração & dosagem , Resultado do Tratamento , Triazóis/administração & dosagemRESUMO
Gastroesophageal reflux disease (GERD) is highly prevalent in the Western world. Patients with GERD have a 10 fold increased risk to develop a Barrett's esophagus. Patients with Barrett's esophagus have a higher risk for an esophageal adenocarcinoma. Men have more severe reflux with a higher grade of inflammation and acid reflux. This seems to be the reason why men develop a Barrett's esophagus more frequently--the risk is approximately 2 to 3 fold and the risk for an esophageal adenocarcinoma is even 3 to 6 times higher.
Assuntos
Esôfago de Barrett/epidemiologia , Neoplasias Esofágicas/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Saúde do Homem/estatística & dados numéricos , Lesões Pré-Cancerosas/epidemiologia , Saúde da Mulher/estatística & dados numéricos , Idoso , Esôfago de Barrett/diagnóstico , Causalidade , Comorbidade , Neoplasias Esofágicas/diagnóstico , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Caracteres Sexuais , Distribuição por SexoRESUMO
BACKGROUND: Detecting early neoplasias in Barrett's oesophagus (BE) is challenging. Recent publications have been focusing on improving the detection of such lesions during Barrett's surveillance. However in a recently published Danish register study calculating the risk for cancer-development in BE two-thirds of the diagnosed tumors were identified during the first examination or in the first year. This means that index endoscopy might be more effective than surveillance in detecting early neoplasia in BE. METHODS: In the period from January 2010 to April 2011, all patients who consecutively presented with a diagnosis of early neoplastic changes in BE were recorded prospectively. ANALYSIS: The analysis included data for 121 patients. In patients with short-segment BE (SSBE), neoplasia was only diagnosed in 6â% of cases in the surveillance examination, compared with 44â% of cases in long-segment BE (LSBE). The neoplastic lesion was identified visually in 43 patients (36â%) during the external EGD. Type II tumours were detected in 40â% (39/98) and were correctly assessed as neoplastic in 25â% of cases (24/98). CONCLUSIONS: 1. in patients with SSBE almost all early tumours are diagnosed by index endoscopy and not by Barrett's surveillance; 2. around 40â% of all early neoplasias are endoscopically invisible and are only diagnosed using four-quadrant biopsies; 3. the macroscopic tumour type has a substantial influence on the detection rate for neoplasia. If efforts to increase the detection rate for early neoplasia in BE are focused solely on the Barrett's surveillance method, then only a minority of patients - 20â% in the present group - will benefit from the measure. German clinical trials register, DRKS00â004â168.
Assuntos
Esôfago de Barrett/patologia , Detecção Precoce de Câncer/métodos , Neoplasias Esofágicas/patologia , Esofagoscopia/métodos , Esôfago/patologia , Lesões Pré-Cancerosas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Iron overload in MR-imaging with decreased signal intensity in T2 weighting of liver, spleen, adrenal gland and pituitary gland in combination with an extremely elevated ferritin level of 9859â ng/mL and a positive family history of hyperferritinaemia led to the diagnosis of the rare hemochromatosis type 4 (synonym: ferroportin disease) in the case of a 62-year-old patient. The autosomal dominant disease was confirmed by analysis of the SLC40A1-gene. Histologically, a liver cirrhosis was detected. This was neither detectable in the case of the two similarly aged cousins (ferritin about 4750â ng/mL, transferrin saturation normal), nor in the case of the 82-year-old mother (ferritin 7860â ng/dL, transferrin saturation 58â%). Hemochromatosis type 4 with worldwide less than 200 described cases is caused by a disorder of the hepcidin ferroportin metabolism, which regulates the iron export from the cells. A hepatocellular carcinoma may occur even without cirrhosis. Therefore, surveillance of these patients is necessary. Treatment options are therapeutic phlebotomies and alternatively iron-chelating drugs (Deferoxamin, Deferasirox) if the patient develops anaemia.
Assuntos
Catarata/congênito , Hemocromatose/congênito , Hemocromatose/patologia , Distúrbios do Metabolismo do Ferro/congênito , Idoso de 80 Anos ou mais , Catarata/patologia , Diagnóstico Diferencial , Feminino , Humanos , Distúrbios do Metabolismo do Ferro/patologia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-IdadeAssuntos
Anemia Ferropriva/etiologia , Endoscopia por Cápsula , Gastroscopia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Gástrica/diagnóstico , Diagnóstico Diferencial , Feminino , Fundoplicatura , Hérnia Hiatal/cirurgia , Humanos , Laparoscopia , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/etiologia , Úlcera Péptica Hemorrágica/cirurgia , Úlcera Gástrica/etiologia , Úlcera Gástrica/cirurgiaAssuntos
Dor Abdominal/etiologia , Dor Abdominal/patologia , Anemia Ferropriva/etiologia , Anemia Ferropriva/patologia , Síndrome de Peutz-Jeghers/diagnóstico , Síndrome de Peutz-Jeghers/patologia , Actinas/análise , Diagnóstico Diferencial , Enteroscopia de Duplo Balão , Feminino , Humanos , Mucosa Intestinal/patologia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/patologia , Ultrassonografia , Adulto JovemRESUMO
INTRODUCTION: The Merendino (MER) procedure has been evaluated as an alternative to transthoracic esophageal resection (TER) for early stage Barrett's carcinoma. Apart from reducing morbidity and mortality, improvements concerning postoperative health-related quality of life (HRQL) have been postulated. The aim of our study was to compare HRQL between these procedures. MATERIALS AND METHODS: Between July 2000 and July 2007, 117 patients with early Barrett's carcinoma underwent surgery. Patients with tumor recurrence were excluded from the study. HRQL was assessed 1 and 2 years after surgery using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (EORTC-QLQ-C30) and the QLQ-OES18 module. Patients recently diagnosed with early Barrett's carcinoma served as controls. Symptoms that showed a difference of more than ten between the control and the study groups were considered clinically relevant and were tested for significant differences between the study groups using the Mann-Whitney U test (p < 0.05). RESULTS: The response rates for the questionnaires ranged between 70 and 93 %. In the MER group, more items reflected a clinical relevant impairment of HRQL than in the TER group. Significant complaints in the MER group included nausea/vomiting, appetite loss, local pain, difficulties with social eating, and choking. Moreover, we found a significant restriction concerning global health and emotional and social functioning in this group 1 year after surgery. 2 years postoperatively, hardly any differences between the operative techniques could be detected. The only symptom in favor of the MER procedure was a better dysphagia score postoperatively. CONCLUSION: Our study suggests that MER procedure is not superior to subtotal esophagectomy with regard to HRQL.
Assuntos
Esôfago de Barrett/patologia , Esôfago de Barrett/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Qualidade de Vida , Idoso , Esôfago de Barrett/mortalidade , Estudos de Coortes , Intervalo Livre de Doença , Diagnóstico Precoce , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Toracotomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND AND STUDY AIMS: Radiofrequency ablation (RFA) is safe and effective for the eradication of neoplastic Barrett's esophagus; however, occasionally there is minimal regression after initial circumferential balloon-based RFA (c-RFA). This study aimed to identify predictive factors for a poor response 3 months after c-RFA, and to relate the percentage regression at 3 months to the final treatment outcome. METHODS: We included consecutive patients from 14 centers who underwent c-RFA for high grade dysplasia at worst. Patient and treatment characteristics were registered prospectively. "Poor initial response" was defined as < 50 % regression of the Barrett's esophagus 3 months after c-RFA, graded by two expert endoscopists using endoscopic images. Predictors of initial response were identified through logistic regression analysis. RESULTS: There were 278 patients included (median Barrett's segment C4M6). In poor initial responders (n = 36; 13 %), complete response for neoplasia (CR-neoplasia) was ultimately achieved in 86 % (vs. 98 % in good responders; P < 0.01) and complete response for intestinal metaplasia (CR-IM) in 66 % (vs. 95 %; P < 0.01). Poor responders required 13 months treatment (vs. 7 months; P < 0.01) for a median of four RFA sessions (vs. three; P < 0.01). We identified four independent baseline predictors of poor response: active reflux esophagitis (odds ratio [OR] 37.4; 95 % confidence interval [CI] 3.2 - 433.2); endoscopic resection scar regeneration with Barrett's epithelium (OR 4.7; 95 %CI 1.1 - 20.0); esophageal narrowing pre-RFA (OR 3.9; 95 %CI 1.0 - 15.1); and years of neoplasia pre-RFA (OR 1.2; 95 %CI 1.0 - 1.4). CONCLUSIONS: Patients with a poor initial response to c-RFA have a lower ultimate success rate for CR-neoplasia/CR-IM, require more treatment sessions, and a longer treatment period. A poor initial response to c-RFA occurs more frequently in patients who regenerate their endoscopic resection scar with Barrett's epithelium, and those with ongoing reflux esophagitis, neoplasia in Barrett's esophagus for a longer time, or a narrow esophagus.
Assuntos
Adenocarcinoma/cirurgia , Esôfago de Barrett/cirurgia , Ablação por Cateter , Neoplasias Esofágicas/cirurgia , Lesões Pré-Cancerosas/cirurgia , Adenocarcinoma/patologia , Idoso , Esôfago de Barrett/patologia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Técnicas de Apoio para a Decisão , Neoplasias Esofágicas/patologia , Esofagoscopia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
BACKGROUND: The introduction of the S3 guideline on "Sedation in Gastrointestinal Endoscopy" in 2008 led to substantial organisational, structural, staffing-related, financial, and legal changes in the everyday work of departments of gastrointestinal endoscopy. This study examines the economic effects of this and the change in the legal situation. In addition, the extent to which the guideline has been implemented was assessed using an electronic questionnaire circulated to the members of the Working Group of Head Gastroenterologists in Hospitals (ALGK). METHODS: The increased financial burden in the area of staff costs resulting from correct compliance with the sedation guideline was calculated using research figures from an endoscopy department in a maximum-care non-university hospital, dating from 2009. Interpretation of the legal implications of the guideline was provided by lawyers familiar with medical legislation. The question of the extent to which the guideline has been implemented in everyday clinical practice in endoscopy departments in 2011 was investigated using an evaluation questionnaire sent to the members of the ALGK. RESULTS: Implementation of the S3 sedation guideline leads to a substantial increase in the financial burden in the area of staff costs. Assuming 8000 in-patient endoscopy procedures, a conservative estimate indicates extra costs amounting to 257 462.- per year (gross costs for the employer). The analysis of the questionnaire sent to ALGK members on the implementation of the S3 guideline 3 years after its publication showed that its major points, particularly the deployment of a third staff member for sedation, have not been acted on. CONCLUSIONS: The S3 guideline on "Sedation in Gastrointestinal Endoscopy" leads to a substantial increase in the financial burden in the area of staff costs by requiring the presence of a third person exclusively concerned with sedation. This recommendation was issued by the authors of the guideline without any evidence being available. In addition, it leads to a clear change in the legal situation, which in case of claims arising is associated with substantial implications for the physician responsible. The questionnaire evaluation among the members of the ALGK showed that the guideline has not so far been implemented in in-patient gastroenterology.
Assuntos
Sedação Consciente/economia , Sedação Consciente/estatística & dados numéricos , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/normas , Custos de Cuidados de Saúde/estatística & dados numéricos , Modelos Econômicos , Guias de Prática Clínica como Assunto , Simulação por Computador , Alemanha/epidemiologia , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , HospitalizaçãoRESUMO
BACKGROUND AND STUDY AIMS: Endoscopic treatment is increasingly being accepted for early Barrett's cancer (EBC), as it is associated with few complications, excellent long-term results, and almost no mortality. This study investigated current standards and treatment strategies for EBC in eight countries in Western Europe. METHODS: A standardized questionnaire with questions on the endoscopic diagnosis, staging, and treatment of EBC was developed and sent to 107 university gastroenterology departments. The data were analyzed anonymously. RESULTS: The response rate was 49 % (52/107). For work-up of early Barrett's neoplasia, 67 % of hospitals use high-resolution endoscopes, with routine four-quadrant and targeted biopsies of visible lesions in 94 % of the cases. Narrow-band imaging and chromoendoscopy are used in 67 % of the cases, and other advanced imaging and staining techniques in 65 %. Before treatment, 63 % of the respondents recommended conventional endosonography, 6 % miniprobe endosonography, and 19 % both. Endoscopic resection is carried out at 98 % of the hospitals. Argon plasma coagulation is used for ablation in 52 % of the cases and radiofrequency ablation in 27 %. An 80-year-old patient with localized mucosal EBC would be treated endoscopically in all of the hospitals. Endoscopic therapy was recommended for 50-year-old patients with mucosal EBC by 87 % of the hospitals; esophageal resection was recommended for multifocal EBC by 15 % in 80-year-old patients, by 63 % in 50-year-old patients and by 44 % in patients with incipient submucosal infiltration. CONCLUSIONS: About two-thirds of the university hospitals use high-resolution endoscopy and advanced imaging. Endoscopic therapy is the accepted standard for treating localized mucosal Barrett's cancer in Western Europe; esophageal resection is recommended by the majority (63 %) for a young patient with multifocal EBC.
Assuntos
Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Endoscopia Gastrointestinal/estatística & dados numéricos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Hospitais Universitários/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Esôfago de Barrett/epidemiologia , Comorbidade , Neoplasias Esofágicas/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Gastroenterologia/estatística & dados numéricos , Humanos , Masculino , Prevalência , Resultado do TratamentoRESUMO
Endoscopic treatment of early gastric cancer has been shown to be effective and safe. It is a minimally invasive and organ-preserving treatment approach that can safely be used as an alternative to surgical resection. A prerequisite of any endoscopic treatment with a curative intent is a very low risk of lymph node metastasis of the lesion intended to be endoscopically resected. As in high-volume surgical centers all endoscopic procedures with a curative intent should also be carried out in centers with a high expertise in the different endoscopic resection (ER) techniques available, the major techniques being suck-and-cut ER and endoscopic submucosal dissection (ESD). Because of the risk of secondary neoplasia after curative endoscopic therapy, a standardized follow-up protocol is required. The majority of secondary neoplastic lesions can again be treated endoscopically. In the present article an overview of initial staging procedures, techniques, indications, as well as follow-up strategies after endoscopic therapy for early gastric cancer is given.
Assuntos
Gastroscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Lesões Pré-Cancerosas/cirurgia , Neoplasias Gástricas/cirurgia , Dissecação/métodos , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Humanos , Metástase Linfática/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão , Lesões Pré-Cancerosas/patologia , Prognóstico , Neoplasias Gástricas/patologia , SucçãoRESUMO
In several publications including more than 1,000 endoscopically treated patients it could be demonstrated that endoscopic treatment of early esophageal cancer is effective and safe. A combination of endoscopic resection (ER) of early Barrett's neoplasia followed by ablation of the remaining non-dysplastic Barrett's mucosa was able to significantly reduce the rate of recurrence and metachronous neoplasia. Long-term complete remission rates of more than 95% can be achieved. Compared to esophagectomy, endoscopic treatment has only a very low complication rate and almost no mortality. Therefore, ER is the treatment of choice and recommended by several international guidelines. Esophageal resection only plays a minor role in patients with early esophageal cancer.