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Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

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World Journal of Gastroenterology 2016年第39期22卷 8831-8843页

作者： Harsha Moole Jaymon Patel Zohair Ahmed Abhiram Duvvuri Sreekar Vennelaganti Vishnu Moole Sowmya Dharmapuri Raghuveer Boddireddy Pratyusha Yedama Naveen Bondalapati Achuta Uppu Prashanth Vennelaganti Srinivas Puli Department of Medicine University of Illinois College of Medicine at Peoria Division of Gastro-enterology and Hepatology Kansas City Veteran Affairs Medical Center Department of Medicine Apogee Medical Group Department of Medicine NTR University of Health Sciences Department of Medicine Barnes Jewish Christian Medical Group Christian Hospital Department of Medicine Albert Einstein College of Medicine Division of Gastroenterology and Hepatology University of Kansas Medical Center Division of Gastroenterology and Hepatology University of Illinois College of Medicine at Peoria

AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert *** Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. RESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIR) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIR of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIR of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIR of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

关键词： Barrett’s esophagus Low grade dysplasia high grade dysplasia Esophageal adenocarcinoma Annual incidence of progression Systematic review Meta-analysis

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Histological healing favors lower risk of colon carcinoma in extensive ulcerative colitis

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World Journal of Gastroenterology 2014年第17期20卷 4980-4986页

作者： Burton I Korelitz Keith Sultan Megha Kothari Leo Arapos Judy Schneider Georgia Panagopoulos Department of Gastroenterology Lenox Hill HospitalNew YorkNY 10075United States Department of Gastroenterology and Hepatology and Nutrition North Shore HospitalManhassetNY 11030United States North Oaks Medical Center HammondLA 70403United States Department of Research Lenox Hill HospitalNew YorkNY 10075United States

AIM: To search for the answer in extensive ulcerative colitis as to whether histological inflammation persisting despite endoscopic mucosal healing serves to increase the risk of colon cancer (CC) or high grade dyspla... 详细信息

关键词： Histological inflammation Risk Colon cancer Ulcerative colitis high grade dysplasia

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Squamous cell carcinoma after radiofrequency ablation for Barrett's dysplasia

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World Journal of Gastroenterology 2014年第15期20卷 4453-4456页

作者： Sebastian S Zeki Rehan Haidry Manuel Justo-Rodriguez Laurence B Lovat Nicholas A Wright Stuart A McDonald Centre for Tumour Biology Bart’s Cancer InstituteLondon EC1M 6BQUnited Kingdom Research Department of General Surgery University College LondonLondon WC1E 6BTUnited Kingdom Department of Pathology University College LondonLondon WC1E 6BTUnited Kingdom

Barrett’s oesophagus(BO)is a usually indolent condition that occasionally requires endoscopic *** ablation(RFA)is an effective endoscopic treatment for high grade dysplasia(HGD)and intramucosal cancer in *** has a good efficacy,durability and safety profile although complications can *** we describe a case of RFA in a patient with high grade *** the response to treatment was initially very good with the development of neosquamous epithelium,the patient very rapidly developed a squamous cell cancer of the oesophagus confirmed on radiology,histology and *** sequencing confirmed that the original HGD and the squamous cell cancer(SCC)were derived from separate clonal *** report highlights the fact that SCC of the oesophagus has been noted after endoscopic ablation for BO previously and suggest that ablation of BO may encourage the clonal expansion of cells carrying carcinogenic mutations once a dominant clonal population has been eradicated.

关键词： Squamous carcinoma oesophagus Barrett's oesophagus Radiofrequency ablation Squamous cell cancer high grade dysplasia

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