Techniques in Gastrointestinal Endoscopy最新文献

{"title":"Screening patients for Barrett esophagus: Why, who, and how","authors":"Liam Zakko MD ,&nbsp;Kavel Visrodia MD ,&nbsp;Cadman Leggett MD ,&nbsp;Lori Lutzke LPN ,&nbsp;Kenneth K. Wang MD","doi":"10.1016/j.tgie.2018.05.001","DOIUrl":"10.1016/j.tgie.2018.05.001","url":null,"abstract":"<div><p>Although esophageal adenocarcinoma<span> is an uncommon cancer, it is often fatal unless found at an early disease stage. Screening to discover early stage disease for its only known precursor, Barrett esophagus, is currently the only solution to improve survival. Multiple strategies have been suggested for screening including identification of a higher risk population using epidemiological factors such as sex, age, symptoms of reflux, and presence of central obesity. In addition, new nonendoscopic methods of screening have been created including sponges, balloons, breath tests, and tests on various bodily fluids. All of these new developments were created in order to improve the efficacy and cost-effectiveness of screening. New technologies may allow for a low-cost, noninvasive screening technology that is highly acceptable to healthy patients at risk for esophageal cancer.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45217212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chapter 2: Role of pathologic confirmation for Barrett′s esophagus and dysplasia","authors":"Esther Klaver MD ,&nbsp;Myrtle J. van der Wel MD ,&nbsp;Sybren L. Meijer MD, PhD ,&nbsp;Jacques J.G.H.M. Bergman MD, PhD ,&nbsp;Roos E. Pouw MD, PhD","doi":"10.1016/j.tgie.2018.03.002","DOIUrl":"10.1016/j.tgie.2018.03.002","url":null,"abstract":"<div><p><span><span><span>Barrett′s esophagus (BE) is a premalignant condition defined by the replacement of squamous epithelium by </span>columnar epithelium in the distal part of the esophagus. Patients with BE have an increased risk of progression to </span>esophageal adenocarcinoma<span><span> (EAC). Advanced EAC has a poor 5-year survival rate. However, if EAC is diagnosed at an early stage, endoscopic treatment has proven to be a safe and effective treatment, with excellent long-term survival rates. Currently it is not possible to accurately predict which patients with BE will develop EAC. Despite promising developments in genetic and molecular biomarker research, grade of </span>dysplasia is still the best predictor for progression to EAC. Present guidelines advise surveillance </span></span>endoscopies with biopsies for BE patients to detect early neoplasia at a treatable stage. Surveillance intervals are determined by length of the BE segment and on the histopathologic diagnosis of the biopsies. Accurate histopathologic assessment of biopsies to define surveillance intervals or to decide on a treatment strategy, is therefore of the utmost importance.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43098007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of low-grade dysplasia in Barrett’s esophagus: Ablate or survey?","authors":"Samuel Han MD,&nbsp;Sachin Wani MD","doi":"10.1016/j.tgie.2018.03.001","DOIUrl":"10.1016/j.tgie.2018.03.001","url":null,"abstract":"<div><p><span><span><span>There are several issues that continue to make the management of Barrett’s esophagus and low-grade dysplasia challenging especially in terms of determining the optimal management strategy—surveillance vs endoscopic </span>eradication therapy (EET). Some of these include a highly variable rate of neoplastic progression to high-grade dysplasia or cancer and significant interobserver variability among </span>pathologists (including expert gastrointestinal pathologists). The efficacy and effectiveness of EET, predominantly using </span>radiofrequency ablation, in reducing the risk of progression has been well described. However, there are limited data that define the ideal candidates most likely to benefit from EET compared with surveillance. This review discusses the challenges in the diagnosis and management of Barrett’s esophagus with low-grade dysplasia, provides practice advice for this patient population and the need for physicians to incorporate quality indicators in clinical practice.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47500408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barrett esophagus: Current standards and future directions","authors":"Bashar Qumseya MD, MPH (Guest Editor)","doi":"10.1016/j.tgie.2018.04.001","DOIUrl":"10.1016/j.tgie.2018.04.001","url":null,"abstract":"","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47375837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection compared to endoscopic mucosal resection for early Barrett esophagus neoplasia","authors":"Dennis Yang MD,&nbsp;Peter V. Draganov MD","doi":"10.1016/j.tgie.2018.02.001","DOIUrl":"10.1016/j.tgie.2018.02.001","url":null,"abstract":"<div><p><span><span>Endoscopic resection has become an invaluable diagnostic and therapeutic tool in the evaluation and management of early </span>Barrett esophagus (BE) neoplasia. While </span>endoscopic mucosal resection<span> (EMR) is the current standard of care for the resection of nodular early BE neoplasia, endoscopic submucosal dissection<span> (ESD) has been recently introduced as part of the armamentarium in the treatment of these lesions. The potential advantages of ESD compared to EMR include higher en-bloc and R0 resection rates, decreased local recurrence, and the procurement of large en-bloc specimens that may facilitate pathologic staging. On the other hand, EMR is less time-consuming and has been traditionally associated with a lower incidence of serious adverse events when compared to ESD. At present, the choice of the endoscopic resection technique hinges on operator’s preferences, patient and lesions characteristics and available local expertise. Future high-quality studies comparing clinical outcomes between ESD and EMR are needed to better define their roles in the management of early BE neoplasia.</span></span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.02.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46471552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic eradication therapy for Barrett’s esophagus: Adverse outcomes, patient values, and cost-effectiveness","authors":"Swarup Kumar MD ,&nbsp;Prasad G. Iyer MSc","doi":"10.1016/j.tgie.2018.02.002","DOIUrl":"10.1016/j.tgie.2018.02.002","url":null,"abstract":"<div><p><span>Endoscopic therapy<span><span> for Barrett’s esophagus (BE) aims to replace dysplastic BE epithelium with neosquamous epithelium to prevent and reduce the risk of progression to </span>esophageal adenocarcinoma<span> (EAC) and treat early-stage EAC. Various modalities of endotherapy of dysplastic BE are described. Although endoscopic therapy is safe and effective in treating subjects with intramucosal carcinoma (IMCa), high-grade dysplasia<span> (HGD), and confirmed low-grade dysplasia (LGD), challenges to successful treatment are being recognized. Though </span></span></span></span>adverse outcomes<span> of endotherapy such as bleeding, perforation, pain, and stricture formation are observed, they are not common and can usually be treated medically or endoscopically. Patient values and preferences toward endoscopic therapy and the cost-effectiveness of these endoscopic approaches also have crucial implications for the selection of appropriate treatment and subsequent outcomes in patients with BE.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.02.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55156148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening and surveillance of Barrett esophagus with confocal endomicroscopy and volumetric laser endoscopy","authors":"Anam Khan MD ,&nbsp;Mohamed M. Abdelfatah MD ,&nbsp;Mohamed O. Othman MD","doi":"10.1016/j.tgie.2018.04.002","DOIUrl":"10.1016/j.tgie.2018.04.002","url":null,"abstract":"<div><p><span><span>Barrett esophagus (BE) is a premalignant condition that progresses to </span>esophageal adenocarcinoma<span> through an intermediate stage known as dysplasia. Current guidelines recommend that individuals with BE undergo periodic endoscopic surveillance with white light </span></span>endoscopy<span><span> and random, 4-quadrant biopsies to identify and treat dysplasia. However, this surveillance strategy is limited by random sampling error and low sensitivity. Surveillance with random biopsies can miss up to 43%-57% of early neoplasia. This review will discuss the current role of 2 advanced imaging techniques<span>, ie, confocal laser endomicroscopy (CLE) and volumetric laser endoscopy (VLE) in screening and surveillance for BE. CLE has the highest accuracy of any endoscopic technique and increases the diagnostic yield and sensitivity for dysplasia and intramucosal neoplasia and reduces the need for unnecessary biopsies. However, CLE is capable of imaging only a small field of </span></span>mucosa<span><span> and needs to be incorporated with other advanced imaging techniques to identify suspicious areas that need endomicroscopic evaluation. CLE can be used for the endoscopic evaluation of BE and for the accurate estimation of lesions’ extent and lateral margins to guide endoscopic treatment. CLE is not helpful in assessing the depth of invasion of early neoplastic lesions or in endoscopic surveillance after ablative or resective therapy. VLE is a new imaging modality with limited studies. However, early experience suggests that VLE appears to be a valuable imaging modality in its ability to identify subsquamous BE and buried Barrett glands after mucosal ablation. Overall, CLE and VLE have not been adopted widely due to limited availability, high cost, and need for specific operator training. The major limitation of all studies assessing the role of CLE and VLE in screening and surveillance for BE is that they were all performed by expert endoscopists in tertiary referral centers with a population enriched regarding the proportion of patients with dysplasia. Despite developments in advanced imaging techniques, these techniques are not included in standard surveillance guidelines, and </span>white light endoscopy with random biopsies remains the gold standard for BE surveillance.</span></span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48859231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound guided fine-needle aspiration and biopsy of pancreatic cysts","authors":"Mohit Girotra MD, FACP ,&nbsp;Walter G. Park MD, MS","doi":"10.1016/j.tgie.2017.10.004","DOIUrl":"10.1016/j.tgie.2017.10.004","url":null,"abstract":"<div><p><span>Pancreatic cystic lesions<span><span> (PCLs) are often incidentally found on cross-sectional imaging. Long strides have been made in the past decade with improved quality and optics of cross-sectional imaging and endoscopic ultrasound (EUS), but a singular reliable test to appropriately characterize and risk-stratify PCLs has still eluded us. EUS allows high-resolution imaging of the pancreatic parenchyma and the ductal system, for assessment of PCL characteristics, with features concerning for </span>malignancy and additionally provides an opportunity to sample the cyst to obtain fluid or cells for further diagnostic testing. This presents new sets of challenges, which include devising suitable equipment or needles and techniques for reliable and safe tissue acquisition, as well as provision of an adequate </span></span>cytology<span> or tissue sample to the pathologist, in order to arrive at an accurate diagnosis. This article will review the current role of EUS in the diagnosis and characterization of PCLs, with a focus on available strategies and pitfalls of cytology, cyst-fluid biomarkers, and biopsy acquisition techniques; and future directions to increase the yield and accuracy.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.10.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55156033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-guided tissue acquisition of liver and hepatobiliary masses","authors":"Phillip S. Ge MD,&nbsp;Marvin Ryou MD","doi":"10.1016/j.tgie.2017.11.003","DOIUrl":"10.1016/j.tgie.2017.11.003","url":null,"abstract":"<div><p>Endoscopic ultrasound<span> (EUS) is increasingly used in the evaluation of hepatobiliary lesions and for obtaining liver biopsies. EUS-guided tissue acquisition is safe and effective, with high diagnostic yield and low major complication rate. This article reviews the techniques and clinical outcomes of EUS-guided tissue acquisition of hepatobiliary masses as well as EUS-guided liver biopsy.</span></p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2017.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41854029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Devices for endoscopic ultrasound-guided tissue acquisition","authors":"Thiruvengadam Muniraj MD, PhD,&nbsp;Harry R. Aslanian MD","doi":"10.1016/j.tgie.2018.01.003","DOIUrl":"10.1016/j.tgie.2018.01.003","url":null,"abstract":"<div><p><span>Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has greatly evolved since the first EUS-guided fine-needle aspiration was reported 25 years ago. EUS-TA has become the procedure of choice for sampling of the pancreas, subepithelial lesions, and other structures adjacent to the gastrointestinal tract. Initial EUS devices were needles, primarily for performing fine-needle aspiration. Newer EUS devices have expanded the capabilities of the endosonographer to include TA for histologic evaluation, </span>in vivo microscopy, fiducial placement, and EUS-based therapeutic interventions. This review will focus on the devices for use with EUS that are currently approved in the US including those for EUS-TA as well as other modalities.</p></div>","PeriodicalId":43887,"journal":{"name":"Techniques in Gastrointestinal Endoscopy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tgie.2018.01.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55156110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}