Recent findings

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.

Mathematical modeling of optimal screening age for Barrett's

Kit Curtius and colleagues from the U.S. and India demonstrate how mathematical modeling of cancer evolution can be used to optimize age at initial screening for Barrett's and esophageal adenocarcinoma. Their research suggests that optimal screening ages for patients with symptomatic gastroesophageal reflux are older (58 for men, 64 for women) than what is currently recommended (age > 50 years.)

EAC incidence continues to rise in Switzerland

EAC became the most common form of esophageal cancer in Switzerland around 2010. From the authors' conclusions:A significant increase in the incidence of adenocarcinoma of the oesophagus was observed in Switzerland during thestudy period 1986-2015. A parallel rise of GORD and obesity over the same period may, at least partially, be responsible for this trend. For oesophageal squamous cell carcinoma, a decreasing trend was only observed in males most likely related to sex-specific lifestyle changes.

Inherited susceptibility to GERD

Over 350,000 records were analyzed to identify genetic markers (SNPs) and genes related to the prevalence of GERD (gastroesophageal reflux.) 25 new loci were identified, most of which also associated with increased risk of Barrett's and/or esophageal adenocarcinoma. Three of the target genes are already GERD/EA/BE drug targets and four others are drug targets for other diseases and as such would be very interesting to investigate for potential medication repurposing for reflux, BE, or EA.

Predicting presence of Barrett's

Strengths of this risk prediction model for Barrett's includes the relatively large number of cases and an external validation dataset. A limitation is that only those with symtomatic GERD (reflux) were included, so this is not necessarily generalizable to the general adult population. The authors observed that age, sex, cigarette smoking, waist circumference, frequency of stomach pain, duration of heartburn and acidic taste, and taking antireflux medication were predictive with an AUC of 0.81 in validation set.

What happens after ablation for Barrett's?

This review paper summarizes some of the current issues in surveillance and treatment after endoscopic eradication therapy (e.g., RFA) for Barrett's dysplasia.

Optimizing Barrett's management

Investigators in the CISNET Esophagus consortium employed comparative modeling to develop recommendations on clinical management (surveillance frequency and endoscopic eradication therapy) of persons with low grade or non-dysplastic Barrett's esophagus.
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 ©2021
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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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