Latest Developments in the Endoscopic Management of Gastroesophageal Reflux Disease and Barrett’s Esophagus: an Overview of the Year’s Literature

The development of endoscopic techniques for the treatment of gastroesophageal reflux disease has come to an abrupt halt after some of the most widely disseminated and best evaluated techniques were withdrawn from the market. This underlines the importance of conducting high-quality endoscopic research before techniques are adopted in routine practice.
The endoscopic surveillance of patients with Barrett’s esophagus needs to be improved in order to be cost-effective. Alternative techniques for tissue sampling are being explored (e. g., brush cytology, imaging cytometry), as well as the use of molecular markers, to select patients who are at risk and to improve compliance by patients. New endoscopic imaging techniques (such as autofluorescence endoscopy) may improve the detection of early neoplasia in those Barrett’s patients who are at risk for malignant degeneration. Subsequent endoscopic treatment should primarily consist of an endoscopic resection technique with restricted use of ablative therapies. Future studies should focus on the development of endoscopic resection techniques that allow en-bloc resection of Barrett’s lesions, stepwise complete resection of the whole Barrett’s segment, and/or easier and safer tissue ablation. Finally, histopathological studies are needed in order to detect risk factors for an adverse outcome after endoscopic treatment for early neoplasia in Barrett’s patients.

References

• 1 Pleskow D, Rothstein R, Lo S. et al . Endoscopic full-thickness plication for the treatment of GERD: 12-month follow-up for the North American open-label trial.  Gastrointest Endosc. 2005;  61 643-649
• 2 Cohen L B, Johnson D A, Ganz R A. et al . Enteryx implantation for GERD: expanded multicenter trial results and interim postapproval follow-up to 24 months.  Gastrointest Endosc. 2005;  61 650-658
• 3 Chen Y K, Raijman I, Ben Menachem T. et al . Long-term outcomes of endoluminal gastroplication: a U. S. multicenter trial.  Gastrointest Endosc. 2005;  61 659-667
• 4 Devière J, Costamagna G, Neuhaus H. et al . Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial.  Gastroenterology. 2005;  128 532-540
• 5 Corley D A, Katz P, Wo J M. et al . Improvement of gastroesophageal reflux symptoms after radiofrequency energy: a randomized, sham-controlled trial.  Gastroenterology. 2003;  125 668-676
• 6 Shaheen N J. Raising the bar in studies of endoscopic anti-reflux procedures.  Gastroenterology. 2005;  128 779-782
• 7 Fockens P, Bruno M J, Gabbrielli A. et al . Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: multicenter study of the Gatekeeper Reflux Repair System.  Endoscopy. 2004;  36 682-689
• 8 Schiefke I, Neumann S, Zabel-Langhennig A. et al . Use of an endoscopic suturing device (the ”ESD”) to treat patients with gastroesophageal reflux disease, after unsuccessful EndoCinch endoluminal gastroplication: another failure.  Endoscopy. 2005;  37 700-705
• 9 Hage M, Siersema P D, van Dekken H. et al . Oesophageal cancer incidence and mortality in patients with long-segment Barrett’s oesophagus after a mean follow-up of 12. 7 years.  Scand J Gastroenterol. 2004;  39 1175-1179
• 10 Shaheen N J, Dulai G S, Ascher B. et al . Effect of a new diagnosis of Barrett’s esophagus on insurance status.  Am J Gastroenterol. 2005;  100 577-580
• 11 Weston A P, Sharma P, Mathur S. et al . Risk stratification of Barrett’s esophagus: updated prospective multivariate analysis.  Am J Gastroenterol. 2004;  99 1657-1666
• 12 Dulai G S, Shekelle P G, Jensen D M. et al . Dysplasia and risk of further neoplastic progression in a regional Veterans Administration Barrett’s cohort.  Am J Gastroenterol. 2005;  100 775-783
• 13 Fang M, Lew E, Klein M. et al . DNA abnormalities as marker of risk for progression of Barrett’s esophagus to adenocarcinoma: image cytometric DNA analysis in formalin-fixed tissues.  Am J Gastroenterol. 2004;  99 1887-1894
• 14 Falk G W, Chittajallu R, Goldblum J R. et al . Surveillance of patients with Barrett’s esophagus for dysplasia and cancer with balloon cytology.  Gastroenterology. 1997;  112 1787-1797
• 15 Falk G W, Skacel M, Gramlich T L. et al . Fluorescence in situ hybridization of cytologic specimens from Barrett’s esophagus: a pilot feasibility study.  Gastrointest Endosc. 2004;  60 280-284
• 16 Hillman L C, Chiragakis L, Shadbolt B. et al . Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett’s oesophagus.  Med J Aust. 2004;  180 387-391
• 17 El-Serag H B, Aguirre T V, Davis S. et al . Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus.  Am J Gastroenterol. 2004;  99 1877-1883
• 18 Ouatu-Lascar R, Fitzgerald R C, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression.  Gastroenterology. 1999;  117 327-335
• 19 Schell T G. Acid suppression and adenocarcinoma of the esophagus: cause or cure?.  Am J Gastroenterol. 2004;  99 1884-1886
• 20 Mardini H E. Preventing dysplasia in Barrett’s esophagus: are proton pump inhibitors the answer?.  Am J Gastroenterol. 2005;  100 978-979
• 21 Kara M A, Smits M E, Rosmolen W D. et al . A randomized crossover study comparing light-induced fluorescence endoscopy with standard videoendoscopy for the detection of early neoplasia in Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 671-678
• 22 Kara M A, Peters F P, ten Kate F J. et al . Endoscopic video autofluorescence imaging may improve the detection of early neoplasia in patients with Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 679-685
• 23 Westerterp M, Koppert L B, Buskens C J. et al . Outcome of surgical treatment for early adenocarcinoma of the esophagus or gastro-esophageal junction.  Virchows Arch. 2005;  446 497-504
• 24 Stein H J, Feith M, Bruecher B L. et al . Early esophageal cancer: pattern of lymphatic spread and prognostic factors for long-term survival after surgical resection.  Ann Surg. 2005;  242 566-573
• 25 Vieth M, Ell C, Gossner L. et al . Histological analysis of endoscopic resection specimens from 326 patients with Barrett’s esophagus and early neoplasia.  Endoscopy. 2004;  36 776-781
• 26 Takubo K, Sasajima K, Yamashita K. et al . Double muscularis mucosae in Barrett’s esophagus.  Hum Pathol. 1991;  22 1158-1161
• 27 Peters F P, Kara M A, Rosmolen W D. et al . Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 506-514.
• 28 Behrens A, May A, Gossner L. et al . Curative treatment for high-grade intraepithelial neoplasia in Barrett’s esophagus.  Endoscopy. 2005;  37 999-1005
• 29 Pech O, Gossner L, May A. et al . Long-term results of photodynamic therapy with 5-aminolevulinic acid for superficial Barrett’s cancer and high-grade intraepithelial neoplasia.  Gastrointest Endosc. 2005;  62 24-30
• 30 Peters F, Kara M, Rosmolen W. et al . Poor results of 5-aminolevulinic acid-photodynamic therapy for residual high-grade dysplasia and early cancer in Barrett esophagus after endoscopic resection.  Endoscopy. 2005;  37 418-424
• 31 Van Laethem J L, Peny M O, Salmon I. et al . Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett’s oesophagus.  Gut. 2000;  46 574-577
• 32 Overholt B F, Panjehpour M, Halberg D L. Photodynamic therapy for Barrett’s esophagus with dysplasia and/or early stage carcinoma: long-term results.  Gastrointest Endosc. 2003;  58 183-188
• 33 Krishnadath K K, Wang K K, Taniguchi K. et al . Persistent genetic abnormalities in Barrett’s esophagus after photodynamic therapy.  Gastroenterology. 2000;  119 624-630
• 34 Hage M, van Dekken H, Vissers K J. et al . Molecular aberrations are still present after ablative therapy of Barrett’s esophagus [abstract].  Gastrointest Endosc. 2004;  59 AB249
• 35 Dulai G S, Jensen D M, Cortina G. et al . Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 232-240
• 36 Sampliner R E. The better burn.  Gastrointest Endosc. 2005;  61 241-242
• 37 Satodate H, Inoue H, Yoshida T. et al . Circumferential EMR of carcinoma arising in Barrett’s esophagus: case report.  Gastrointest Endosc. 2003;  58 288-292
• 38 Seewald S, Akaraviputh T, Seitz U. et al . Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma.  Gastrointest Endosc. 2003;  57 854-859
• 39 Giovannini M, Bories E, Pesenti C. et al . Circumferential endoscopic mucosal resection in Barrett’s esophagus with high-grade intraepithelial neoplasia or mucosal cancer: preliminary results in 21 patients.  Endoscopy. 2004;  36 782-787
• 40 Miyamoto S, Muto M, Hamamoto Y. et al . A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms.  Gastrointest Endosc. 2002;  55 576-581
• 41 Rajan E, Gostout C J, Feitoza A B. et al . Widespread EMR: a new technique for removal of large areas of mucosa.  Gastrointest Endosc. 2004;  60 623-627
• 42 Seewald S, Omar S, Groth S. et al . A novel multiband mucosectomy device facilitates circumferential endoscopic mucosal resection in Barrett’s esophagus with early malignant changes [abstract].  Gastrointest Endosc. 2005;  61 AB80
• 43 Ganz R A, Utley D S, Stern R A. et al . Complete ablation of esophageal epithelium with a balloon-based bipolar electrode: a phased evaluation in the porcine and in the human esophagus.  Gastrointest Endosc. 2004;  60 1002-1010