Gastroesophageal Reflux Disease and Barrett’s Esophagus

Several articles have been published during the last year that may affect the management of patients with gastroesophageal reflux disease (GERD) and/or Barrett’s esophagus in the near future. A new method of measuring esophageal pH has been introduced that does not require an indwelling transnasal catheter and may allow a more physiological assessment of esophageal acid exposure. Several articles discussed the use of endoscopic antireflux procedures, and a sham-controlled randomized study was published concerning the Stretta procedure. A long-term follow-up study and a decision analysis study have again fueled the debate concerning the relevance of surveillance of Barrett’s patients, whereas other studies focused on techniques that may improve the detection of specialized intestinal metaplasia and dysplasia within the Barrett’s segment. Finally, several studies have reported promising results with the endoscopic treatment of Barrett’s metaplasia and early neoplasia using ablation techniques or endoscopic resection modalities. This review summarizes the most important articles in the field of GERD and Barrett’s esophagus that have been published in peer-reviewed journals during the last year that are relevant to the practicing endoscopist.

References

• 1 Pandolfino J E, Richter J E, Ours T. et al . Ambulatory esophageal pH monitoring using a wireless system.  Am J Gastroenterol. 2003;  98 740-749
• 2 Ward E M, DeVault K R, Bouras E P. et al . Successful oesophageal pH monitoring with a catheter-free system.  Aliment Pharmacol Ther. 2004;  19 449-454
• 3 Fletcher J, Wirz A, Henry E. et al . Studies of acid exposure immediately above the gastro-oesophageal squamocolumnar junction: evidence of short segment reflux.  Gut. 2004;  53 168-173
• 4 Chuttani R, Sud R, Sachdev G. et al . A novel endoscopic full-thickness plicator for the treatment of GERD: a pilot study.  Gastrointest Endosc. 2003;  58 770-776
• 5 Pleskow D, Rothstein R, Lo S. et al . Endoscopic full-thickness plication for the treatment of GERD: a multicenter trial.  Gastrointest Endosc. 2004;  59 163-171
• 6 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
• 7 Kahrilas P J. Radiofrequency energy treatment of GERD.  Gastroenterology. 2003;  125 970-973
• 8 Conio M, Blanchi S, Lapertosa G. et al . Long-term endoscopic surveillance of patients with Barrett’s esophagus - incidence of dysplasia and adenocarcinoma: a prospective study.  Am J Gastroenterol. 2003;  98 1931-1939
• 9 Inadomi J M, Sampliner R E, Lagergren J. et al . Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis.  Ann Intern Med. 2003;  138 (3) 176-186
• 10 Wei J T, Shaheen N J. Dollars and sense in preventing esophageal cancer.  Gastroenterology. 2003;  125 1268-1270
• 11 Dekel R, Wakelin D E, Wendel C. et al . Progression or regression of Barrett’s esophagus: is it all in the eye of the beholder?.  Am J Gastroenterol. 2003;  98 2612-2615
• 12 Guda N M, Partington S, Vakil N. Inter- and intra-observer variability in the measurement of length at endoscopy: implications for the measurement of Barrett’s esophagus.  Gastrointest Endosc. 2004;  59 655-658
• 13 Toyoda H, Rubio C, Befrits R. et al . Detection of intestinal metaplasia in distal esophagus and esophagogastric junction by enhanced-magnification endoscopy.  Gastrointest Endosc. 2004;  59 15-21
• 14 Yagi K, Nakamura A, Sekine A. Accuracy of magnifying endoscopy with methylene blue in the diagnosis of specialized intestinal metaplasia and short-segment Barrett’s esophagus in Japanese patients without Helicobacter pylori infection.  Gastrointest Endosc. 2003;  58 189-195
• 15 Ragunath K, Krasner N, Raman V S. et al . A randomized, prospective cross-over trial comparing methylene blue-directed biopsy and conventional random biopsy for detecting intestinal metaplasia and dysplasia in Barrett’s esophagus.  Endoscopy. 2003;  35 998-1003
• 16 Canto M I, Yoshida T, Gossner L. Chromoscopy of intestinal metaplasia in Barrett’s esophagus.  Endoscopy. 2002;  34 330-336
• 17 Kara M, Ennahachi M, Fockens P, Peters F P, Ten Kate F, Bergman J J. Narrow-Band Imaging (NBI) in Barrett’s Esophagus (BE): What Features Are Relevant for the Detection of High-grade Dysplasia (HGD) and Early Cancer (EC)? [abstract].  Gastroenterol. 2004;  126 (4) A50
• 18 Endo T, Awakawa T, Takahashi H. et al . Classification of Barrett’s epithelium by magnifying endoscopy.  Gastrointest Endosc. 2002;  55 641-647
• 19 Guelrud M, Herrera I, Essenfeld H. et al . Enhanced magnification endoscopy: a new technique to identify specialized intestinal metaplasia in Barrett’s esophagus.  Gastrointest Endosc. 2001;  53 559-565
• 20 Guelrud M, Ehrlich E E. Endoscopic classification of Barrett’s esophagus.  Gastrointest Endosc. 2004;  59 58-65
• 21 Meining A, Rösch T, Kiesslich R. et al . Inter- and intra-observer variability of magnification chromoendoscopy for detecting specialized intestinal metaplasia at the gastroesophageal junction.  Endoscopy. 2004;  36 160-164
• 22 Stepinac T, Felley C, Jornod P. et al . Endoscopic fluorescence detection of intraepithelial neoplasia in Barrett’s esophagus after oral administration of aminolevulinic acid.  Endoscopy. 2003;  35 663-668
• 23 Niepsuj K, Niepsuj G, Cebula W. et al . Autofluorescence endoscopy for detection of high-grade dysplasia in short-segment Barrett’s esophagus.  Gastrointest Endosc. 2003;  58 715-719
• 24 Haringsma J, Tytgat G N, Yano H. et al . Autofluorescence endoscopy: feasibility of detection of GI neoplasms unapparent to white light endoscopy with an evolving technology.  Gastrointest Endosc. 2001;  53 642-650
• 25 Bergman J J, Kara M A, Smits M E. et al . A randomized cross-over study comparing light-induced fluorescence endoscopy (LIFE) with standard endoscopy (SE) for detection of early neoplasia in Barrett’s esophagus (BE) [abstract].  Gastroenterology. 2003;  124 A 49
• 26 Egger K, Werner M, Meining A. et al . Biopsy surveillance is still necessary in patients with Barrett’s oesophagus despite new endoscopic imaging techniques.  Gut. 2003;  52 18-23
• 27 Kara M A, Peters F P, Fockens P. et al . The first experience with video autofluorescence endoscopy for detection of high-grade dysplasia and early cancer in Barrett’s esophagus [abstract].  Gastroenterology. 2004;  126 A 51
• 28 May A, Gossner L, Behrens A. et al . A prospective randomized trial of two different endoscopic resection techniques for early stage cancer of the esophagus.  Gastrointest Endosc. 2003;  58 167-175
• 29 May A, Gossner L, Pech O. et al . Local endoscopic therapy for intraepithelial high-grade neoplasia and early adenocarcinoma in Barrett’s oesophagus: acute-phase and intermediate results of a new treatment approach.  Eur J Gastroenterol Hepatol. 2002;  14 1085-1091
• 30 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
• 31 Radu A, Grosjean P, Fontolliet C. et al . Endoscopic mucosal resection in the esophagus with a new rigid device: an animal study.  Endoscopy. 2004;  36 298-305
• 32 Ackroyd R, Tam W, Schoeman M. et al . Prospective randomized controlled trial of argon plasma coagulation ablation vs. endoscopic surveillance of patients with Barrett’s esophagus after antireflux surgery.  Gastrointest Endosc. 2004;  59 1-7
• 33 Hage M, Siersema P D, van Dekken H. et al . 5-aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett’s oesophagus: a randomised trial.  Gut. 2004;  53 785-790