Recent findings

Visceral obesity and esophageal cancer

In this remarkably thorough review, Drs. Elliott and Reynolds summarize the evidence for and potential mechanisms underlying the association between visceral (abdominal or central) obesity and risk of esophageal adenocarcinoma, as well as potential roles for associated dietary, lifestyle, pharmacologic and surgical interventions on risk of EAC.

Clinical trial on RFA in low grade dysplasia

Results from this clinical trial on RFA vs. annual surveillance in persons with low grade dysplasia were modestly supportive of RFA in this population, with a 62% reduction in prevalence of Barrett's after three years which was of borderline statistically significance. One or more adverse events were experience by 19% of the RFA group, while spontaneous regression of LGD was observed in almost 1/3 of the surveillance patients. The small size of the study is an important limitation which limits interpretation.

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]

Review of world-wide GI cancer epidemiology

The authors extensively review the epidemiology (incidence, risk factors, prevention) of cancers of the colon, stomach and esophagus across China, the US and Europe

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.

Modeling suggests a role for Cytosponge in post-RFA surveillance

This is one of the first examinations of the Cytosponge as a non-endoscopic method of surveillance in persons who have been treated for dysplasia in Barrett's. Results suggest that it may be more cost-effective than endoscopy.

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.

EAC rates still rising in Czech Republic

Esophageal adenocarcinoma incidence is still rising about 5% per year in both women and men in the Czech republic, along with use of PPIs.

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.

SEER study observes strong inverse association between EAC and use of PPI, statins and aspirin

A SEER-based observational study lends yet more evidence that aspirin, PPIs, statins and possibly metformin may reduce risk of EAC in persons with or without diagnosed Barrett's esophagus.

Copy number instability key to risk prediction in Barrett's

British study lends strong support to use of genomic risk stratification (genomoe-wide copy number instability) to enable earlier intervention for high-risk Barrett's and at the same time reduce the intensity of monitoring and even reduce overtreatment in cases of stable disease.

Utility of Cytosponge demonstrated

This impressive randomized trial observed an approximately 10-fold increase in detection of Barrett's with use of the Cytosponge non-endoscopic test. Nine persons in the Cytosponge group were found to have treatable dysplasia or early stage cancer vs. none in the usual care group.

Barrett's in children

Barrett's in children does occur, but is rare. This cases series demonstrates a very strong preponderance in males. Among a very few children followed over time, several developed low grade dysplasia, but non were observed to progress to high grade dysplasia or cancer.

Restrospective study identifies SSRIs and statins as inversely related to progression in Barrett's

This study evaluated some known and suspected novel risk factors, including a history of colonic adenomas, caffeine usage, histology, and use of statins and SSRIs as predictors of progression in Barrett's.

Obesity related markers and risk of Barrett's and EA

This article summarizes published reports on circulating biomarkers and risk of BE/EAC, finding that higher circulating levels of leptin, glucose, insulin, CRP, IL6, and sTNFR-2 may be associated with an increased risk of esophageal adenocarcinoma or Barrett esophagus.

Review of chemoprevention status for esophageal adenocarcinoma

Dr. Bill Grady and colleagues review the status of chemopreventatives for progression of Barrett's to esophageal adenocarcinoma

Family history of GI cancer and risk of Barrett's

Dr. Rubenstein and colleagues report increased risk of Barrett's associated with a family history of esophageal or colorectal cancer, supporting previous research.

Cost-effectiveness analysis of EET

Cost-effectiveness modeling from UK indicates that endoscopic eradiction therapy for both low and high-grade dysplasia is cost-effective compared to surveillance.

SURF study long term results

Long term outcomes from SURF clinical trial of RFA for low grade dysplasia confirms strong benefit in risk of HGD or esophageal adenocarcinoma.

RIBBON Network confirms progression risk in Barrett's

Ireland consortium estimates progression from Barrett's to esophageal adenocarcinoma or high grade dysplasia, finding risks similar to previous studies, but higher risk among confirmed low grade dysplasias.

Updated ASGE Guidelines for screening and surveillance of Barrett's

In this publication, the American Society for Gastrointestinal Endoscopy updated their guidelines for screening/surveillance of BE.

Nissen-Sleeve may reduce GERD after bariatric surgery

French investigators observed that modification of a standard bariatric surgery technique resulted in low prevalence of post-surgery GERD symptoms.
About
This website contains a curated and opinionated look at recent literature regarding the epidemiology and prevention of esophageal cancer, with an emphasis on esophageal adenocarcinoma. It is developed by Thomas L Vaughan MD, MPH, who can be reached with questions or suggestions through email or his research website.
©2021 Thomas L Vaughan
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This website should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This site does not constitute the practice of any medical or other professional health care advice, diagnosis or treatment. The information on this website represent the views solely of Dr. Vaughan.
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