Yield of Repeat Endoscopy for Barrett's Esophagus After Normal Index Endoscopy
Joel H. RubensteinJennifer BurnsMaria ArasimElizabeth M. FirshtMatthew HarbrechtMarilla A. Opra WiderquistRichard EvansJohn M. InadomiJoy W. ChangWilliam D. HazeltonChin HurJacob E. KurlanderFrancesca LimE. Georg LuebeckPeter W. MacDonaldChanakyaram A. ReddySameer D. SainiSarah TanAkbar K. WaljeeIris Lansdorp‐Vogelaar
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INTRODUCTION: Guidelines suggest 1-time screening with esophagogastroduodenoscopy (EGD) for Barrett's esophagus (BE) in individuals at an increased risk of esophageal adenocarcinoma (EAC). We aimed to estimate the yield of repeat EGD performed at prolonged intervals after a normal index EGD. METHODS: We conducted a national retrospective analysis within the U S Veterans Health Administration, identifying patients with a normal index EGD between 2003 and 2009 who subsequently had a repeat EGD. We tabulated the proportion with a new diagnosis of BE, EAC, or esophagogastric junction adenocarcinoma (EGJAC) and conducted manual chart review of a sample. We fitted logistic regression models for the odds of a new diagnosis of BE/EAC/EGJAC. RESULTS: We identified 71,216 individuals who had a repeat EGD between 1 and 16 years after an index EGD without billing or cancer registry codes for BE/EAC/EGJAC. Of them, 4,088 had a new billing or cancer registry code for BE/EAC/EGJAC after the repeat EGD. On manual review of a stratified sample, most did not truly have new BE/EAC/EGJAC. A longer duration between EGD was associated with greater odds of a new diagnosis (adjusted odds ratio [aOR] for each 5 years 1.31; 95% confidence interval [CI] 1.19–1.44), particularly among those who were younger during the index EGD (ages 19–29 years: aOR 3.92; 95% CI 1.24–12.4; ages 60–69 years: aOR 1.19; 95% CI 1.01–1.40). DISCUSSION: The yield of repeat EGD for BE/EAC/EGJAC seems to increase with time after a normal index EGD, particularly for younger individuals. Prospective studies are warranted to confirm these findings.Keywords:
Esophagogastroduodenoscopy
Barrett's esophagus
Esophagogastroduodenoscopy
Endoscope
Upper endoscopy
Upper gastrointestinal endoscopy
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There are few objective data evaluating the role of flexible endoscopy in the management of penetrating esophageal and neck injuries. A retrospective analysis was performed on 13 trauma patients who had undergone emergent esophagogastroduodenoscopy for the evaluation of potential esophageal injuries. Endoscopy resulted in one true positive (esophageal injury detected), 10 true negatives (normal esophagus), two false positives, and no false negatives. This yielded a sensitivity of 100% and specificity of 83%. There were no complications of endoscopy. We conclude that urgent flexible esophagogastroduodenoscopy is a useful diagnostic procedure in the evaluation of penetrating wounds possibly involving the esophagus.
Esophagogastroduodenoscopy
Esophageal disease
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Objective To study the diagnostic yield of repeat upper gastrointestinal endoscopy for patients with functional dyspepsia ( FD ). Methods A retrospective review of the database including consecutive patients who underwent esophagogastroduodenoscopy at least twice for dyspeptic symptoms at a tertiary endoscopy center from 1996 to 2011 was performed. The patients' age, gender, symptoms and endoscopic and pathological findings were collected and analyzed. Results A total of 2 350 patients with FD with a median age of 50 years, including 1 020 men and 1 330 women, were enrolled. Abdominal pain or discomfort was the main indication for the first endoscopy, and 12.6% of the patients presented with alarm features. At the second endoscopy, non‐atrophic and atrophic gastritis were the most common endoscopic findings and only 12 and 10 patients were found to have peptic ulcers or gastric polyps, respectively. No malignancy was detected at either the first or the repeat endoscopy. Conclusions Significant pathologies within one year after a normal esophagogastroduodenoscopy are very rare for patients with FD . Therefore, a repeat endoscopy within one year after the first endoscopy is not recommended for these patients.
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Gastroduodenal endoscopy is the most commonly accepted method to evaluate the upper gastrointestinal tract. Many surgeons have become familiar with colonoscopy, but few seem to do upper endoscopy. The introduction of the ultraslim endoscope makes office unsedated endoscopy possible. The recent suggestion of more aggressive evaluation of dyspepsia in the screening for Barrett's esophagus suggests this procedure to be both practical and necessary. This procedure is of value to all surgeons, particularly those who are called on to evaluate, treat, and operate on upper gastrointestinal disease.
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There is an unmet need for identifying novel biomarkers in Barrett's esophagus that could stratify patients with regards to neoplastic progression. We investigate the expression patterns of extracellular matrix (ECM) molecules in Barrett's esophagus and Barrett's esophagus-related neoplasia, and assess their value as biomarkers for the diagnosis of Barrett's esophagus-related neoplasia and to predict neoplastic progression. Gene-expression analyses of ECM matrisome gene sets were performed using publicly available data on human Barrett's esophagus, Barrett's esophagus-related dysplasia, esophageal adenocarcinoma (ADCA) and normal esophagus. Immunohistochemical expression of basement membrane (BM) marker agrin (AGRN) and p53 was analyzed in biopsies of Barrett's esophagus-related neoplasia from 321 patients in three independent cohorts. Differential gene-expression analysis revealed significant enrichment of ECM matrisome gene sets in dysplastic Barrett's esophagus and ADCA compared with controls. Loss of BM AGRN expression was observed in both Barrett's esophagus-related dysplasia and ADCA. The mean AGRN loss in Barrett's esophagus glands was significantly higher in Barrett's esophagus-related dysplasia and ADCA compared with non-dysplastic Barrett's esophagus (NDBE; P < 0.001; specificity = 82.2% and sensitivity = 96.4%). Loss of AGRN was significantly higher in NDBE samples from progressors compared with non-progressors (P < 0.001) and identified patients who progressed to advanced neoplasia with a specificity of 80.2% and sensitivity of 54.8%. Moreover, the combination of AGRN loss and abnormal p53 staining identified progression to Barrett's esophagus-related advanced neoplasia with a specificity and sensitivity of 86.5% and 58.7%. We highlight ECM changes during Barrett's esophagus progression to neoplasia. BM AGRN loss is a novel diagnostic biomarker that can identify patients with NDBE at increased risk of developing advanced neoplasia.
Barrett's esophagus
Esophageal disease
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<div>AbstractPurpose:<p>There is an unmet need for identifying novel biomarkers in Barrett's esophagus that could stratify patients with regards to neoplastic progression. We investigate the expression patterns of extracellular matrix (ECM) molecules in Barrett's esophagus and Barrett's esophagus–related neoplasia, and assess their value as biomarkers for the diagnosis of Barrett's esophagus–related neoplasia and to predict neoplastic progression.</p>Experimental Design:<p>Gene-expression analyses of ECM matrisome gene sets were performed using publicly available data on human Barrett's esophagus, Barrett's esophagus–related dysplasia, esophageal adenocarcinoma (ADCA) and normal esophagus. Immunohistochemical expression of basement membrane (BM) marker agrin (AGRN) and p53 was analyzed in biopsies of Barrett's esophagus–related neoplasia from 321 patients in three independent cohorts.</p>Results:<p>Differential gene-expression analysis revealed significant enrichment of ECM matrisome gene sets in dysplastic Barrett's esophagus and ADCA compared with controls. Loss of BM AGRN expression was observed in both Barrett's esophagus–related dysplasia and ADCA. The mean AGRN loss in Barrett's esophagus glands was significantly higher in Barrett's esophagus–related dysplasia and ADCA compared with non-dysplastic Barrett's esophagus (NDBE; <i>P</i> < 0.001; specificity = 82.2% and sensitivity = 96.4%). Loss of AGRN was significantly higher in NDBE samples from progressors compared with non-progressors (<i>P</i> < 0.001) and identified patients who progressed to advanced neoplasia with a specificity of 80.2% and sensitivity of 54.8%. Moreover, the combination of AGRN loss and abnormal p53 staining identified progression to Barrett's esophagus–related advanced neoplasia with a specificity and sensitivity of 86.5% and 58.7%.</p>Conclusions:<p>We highlight ECM changes during Barrett's esophagus progression to neoplasia. BM AGRN loss is a novel diagnostic biomarker that can identify patients with NDBE at increased risk of developing advanced neoplasia.</p></div>
Barrett's esophagus
Esophageal disease
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<div>AbstractPurpose:<p>There is an unmet need for identifying novel biomarkers in Barrett's esophagus that could stratify patients with regards to neoplastic progression. We investigate the expression patterns of extracellular matrix (ECM) molecules in Barrett's esophagus and Barrett's esophagus–related neoplasia, and assess their value as biomarkers for the diagnosis of Barrett's esophagus–related neoplasia and to predict neoplastic progression.</p>Experimental Design:<p>Gene-expression analyses of ECM matrisome gene sets were performed using publicly available data on human Barrett's esophagus, Barrett's esophagus–related dysplasia, esophageal adenocarcinoma (ADCA) and normal esophagus. Immunohistochemical expression of basement membrane (BM) marker agrin (AGRN) and p53 was analyzed in biopsies of Barrett's esophagus–related neoplasia from 321 patients in three independent cohorts.</p>Results:<p>Differential gene-expression analysis revealed significant enrichment of ECM matrisome gene sets in dysplastic Barrett's esophagus and ADCA compared with controls. Loss of BM AGRN expression was observed in both Barrett's esophagus–related dysplasia and ADCA. The mean AGRN loss in Barrett's esophagus glands was significantly higher in Barrett's esophagus–related dysplasia and ADCA compared with non-dysplastic Barrett's esophagus (NDBE; <i>P</i> < 0.001; specificity = 82.2% and sensitivity = 96.4%). Loss of AGRN was significantly higher in NDBE samples from progressors compared with non-progressors (<i>P</i> < 0.001) and identified patients who progressed to advanced neoplasia with a specificity of 80.2% and sensitivity of 54.8%. Moreover, the combination of AGRN loss and abnormal p53 staining identified progression to Barrett's esophagus–related advanced neoplasia with a specificity and sensitivity of 86.5% and 58.7%.</p>Conclusions:<p>We highlight ECM changes during Barrett's esophagus progression to neoplasia. BM AGRN loss is a novel diagnostic biomarker that can identify patients with NDBE at increased risk of developing advanced neoplasia.</p></div>
Barrett's esophagus
Esophageal disease
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Esophagogastroduodenoscopy
Therapeutic Endoscopy
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