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]
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.
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.
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.
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.