Three-tiered screening program proposed
Drs. Yusuf and Fitzgerald review recent technological advancements in screening for Barrett's esophagus and propose a three-tier approach using risk prediction algorithms and minimally invasive approaches to improving detection rate for Barrett's and EAC
Review of Barrett's and Esophageal Adenocarcinoma
The authors review the incidence of BE and EAC and associated risk factors, evidence for improved outcomes among patients with a prior diagnosis of BE compared to those without, discuss the challenges of developing sufficiently accurate prediction models in the context of high population prevalence of risk factors (e.g., obesity, reflux, smoking), and emphasize the need for larger biomarker studies.
Good news in treatment of esophageal cancer
Dr. Ilson's editorial in the New England Journal of Medicine puts new findings regarding the monoclonal antibody, nivolumab, in treatment of esophagal cancer in perspective. [Figure from original research article by Kelly, et al in same issue]
Dutch study on RFA/EMR effectiveness
In an observational study of 1154 patients with BE or early EAC, 94% achieved complete eradication after treatment with RFA/EMR. A dysplasia recurrence rate of 1% per year was observed over a median 43 months.
Young onset esophageal adenocarcinomas have poorer prognosis
Young-onset esophageal adenocarcinoma, while uncommon, is rising in incidence. Concerningly, the proportion of advanced disease continues to increase. Young-onset esophageal adenocarcinoma also presents at more advanced stages, resulting in poorer esophageal adenocarcinoma–free survival.
Predictive model for progression in Barrett's
Using a Bayesian approach, these authors combine results from multiple studies to risk stratify persons with Barrett's. They also identify potential changes in risk associated with preventive measures such as statin use and weight loss.