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The article presents information on endoscopic therapy for Barrett's Oesophagus. Barrett's oesophagus or columnar lined oesophagus is among the most intriguing of gastroenterological conditions. This is because of its pathogenesis, prevalence, association with reflux disease, male sex and, in particular, the potential for neoplastic degeneration to adenocarcinoma. The current and dramatic rise in the incidence of oesophageal adenocarcinoma is centred on Great Britain, over double that of the U.S.A. This epidemic is fairly localised and is not evident in Asia, where squamous cell cancer remains the predominant oesophageal malignancy. Large rises in incidence, up to 30% per year, have been seen in West European White men.

Proposes that mucosal ablation is the procedure of choice to prevent Barrett's esophagus. Removal of the occult cancer by radical surgical removal; Potential problem in the columnar lined esophagus; Reduction of cancer risk by photodynamic therapy.

Proposes that a patient with a clinical diagnosis of Barrett's oesophagus must have regularly endoscopic surveillance and protocol biopsy. Detectable pre-clinical phase for the disease; Advantages of treating the disease before it becomes symptomatic; Acceptability of surveillance to the patient and the health care provider.

Investigates the use of interstitial laser photocoagulation for the treatment of adenocarcinoma of the stomach. Insertion of sapphire into the center of the tumor; Absence of discomfort among patients during the procedure; Problems on the use of endoscopic laser treatment.

Background Barrett's oesophagus (BE) is a premalignant condition leading to oesophageal adenocarcinoma (OAC). Treatment of neoplasia at an early stage is desirable. Combined endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) is an alternative to surgery for patients with BErelated neoplasia. Methods We examined prospective data from the UK registry of patients undergoing RFA/EMR for BE-related neoplasia from 2008 to 2013. Before RFA, visible lesions were removed by EMR. Thereafter, patients had RFA 3- monthly until all BE was ablated or cancer developed (endpoints). End of treatment biopsies were recommended at around 12 months from first RFA treatment or when endpoints were reached. Outcomes for clearance of dysplasia (CR-D) and BE (CR-IM) at end of treatment were assessed over two time periods (2008-2010 and 2011-2013). Durability of successful treatment and progression to OAC were also evaluated. Results 508 patients have completed treatment. CR-D and CR-IM improved significantly between the former and later time periods, from 77% and 56% to 92% and 83%, respectively (p<0.0001). EMR for visible lesions prior to RFA increased from 48% to 60% (p=0.013). Rescue EMR after RFA decreased from 13% to 2% (p<0.0001). Progression to OAC at 12 months is not significantly different (3.6% vs 2.1%, p=0.51). Conclusions Clinical outcomes for BE neoplasia have improved significantly over the past 6 years with improved lesion recognition and aggressive resection of visible lesions before RFA. Despite advances in technique, the rate of cancer progression remains 2-4% at 1 year in these high-risk patients. [ABSTRACT FROM AUTHOR]

Objectives Endoscopic ultrasound (EUS) is recommended for staging gastro-oesophageal cancers but has never been rigorously evaluated. This trial assessed whether EUS, when added to usual staging tests: changes treatment; improves survival and quality of life; and uses resources cost-effectively. Methods We conducted a pragmatic randomised trial in eight centres. As 80% of participants came from two centres, we combined the other centres for analysis. Patients diagnosed with gastro-oesophageal cancer received a standard staging protocol, after which the multi-disciplinary team agreed a provisional management plan. In principle the choice lay between endoscopic mucosal resection, immediate surgery, neoadjuvant chemotherapy followed by surgery, or multi-modal treatment (ie chemotherapy and radiotherapy). We then randomised consenting patients without metastases by telephone to receive EUS or not. Thereafter we recorded changes in the management plan, in the use of healthcare resources and in participant-reported outcomes. In particular we focused on three facets of quality of life: generic (measured by the EQ5D), cancer-related (FACT general scale and subscales) and condition-specific (FACT additional concerns scale). We then followed participants at defined intervals till the end of the trial—that is for between one and 3.5 years. Findings We randomised 223 patients, of whom 213 yielded enough data for primary analysis. At the end of the trial 45% of EUS participants and 32% of the non-EUS participants were alive. EUS improved survival adjusted for generic quality of life with an HR of 0.69 (95% CI 0.49 to 0.98); and both its components—survival and EQ5D scores; the benefits of EUS were significantly greater for those with poor initial quality of life, but there was no difference between centres. Similarly, there was a significant interaction between initial quality of life and the effect of EUS on all the FACT scales; again sicker patients benefitted more from EUS. However, there was no significant difference between EUS and non-EUS groups in mean FACT scores adjusted for covariates. Both management plans and final treatment varied between centres. Although EUS changed the management plan for several participants, differences between groups in actual treatment and the proportion of tumours completely resected were not significant. In both groups, two thirds of initial treatment plans were for chemotherapy followed by surgery, but 40% of participants received multi-modal or palliative treatment. Conclusion EUS has a beneficial effect on survival and generic quality of life, especially for participants initially in poorer health. [ABSTRACT FROM PUBLISHER]

Introduction Raman spectroscopy is a powerful analytical technique that can rapidly and accurately identify biochemical changes in cells that have become neoplastic. We aim to transfer this laboratory based technique to the bedside in order to identify high-grade dysplasia and early malignant change within Barrett's oesophagus. Here we demonstrate the feasibility of a novel fibre-optic Raman probe to map the pathology encountered in a resected human distal oesophagus. Methods A novel Raman probe designed to fit through the 2.8 mm instrument channel of a standard endoscope was used to map a distal oesophagus ex vivo. Following Ivor-Lewis oesophagectomy (with curative intent in patients with oesophageal adenocarcinoma), a reproducible mapping grid was placed over the distal oesophagus and Raman spectra were measured at specified grid positions using 1 and 5 s acquisition times (). A monochromatic 830 nm laser was used for excitation and a Renishaw system 100 spectrometer for the measurement of Raman spectra. PWE-093 Mapping of a distal oesophagus using a perspex grid for probe positioning Results Laboratory based Raman systems can delineate eight pathological groups in the distal oesophagus with sensitivities between 73% and 100%. To date we have measured 76 spectra from 3 oesophageal specimens using the novel endoscopic probe and data collection and analysis is currently on-going (). Histopathological diagnosis has been confirmed by expert pathologists following point biopsy at each grid position in order to correlate the Raman signal with the gold standard. Multivariate analysis will be used to extract subtle spectral features to evaluate the accuracy of the probe for delineating between pathological groups. PWE-093 Example mean Raman probe spectra measured on normal squamous, Barrett's and neoplastic oesophageal tissue Conclusion Further data collection (currently on-going) is needed to generate a robust classification algorithm in order to delineate between Barrett's metaplasia, low/high-grade dysplasia and cancer in the distal oesophagus. Preliminary spectra obtained using a novel endoscopic probe are consistent with laboratory data and suggest profound potential for in vivo endoscopic diagnosis using Raman spectroscopy. [ABSTRACT FROM PUBLISHER]

Introduction: Barrett's metaplasia (BM) is the precursor lesion for oesophageal adenocarcinoma, a tumour with a rising incidence and a uniformly poor prognosis. In spite of the recognition of this fact and the almost exponential increase in clinical and basic science research, much uncertainty remains as to the optimum management of Barrett's metaplasia in terms of screening, surveillance, and treatment. Methods: In order to assess the current situation in the UK an anonymous questionnaire was sent to members of the BSG asking for details of their current practice. Results: Of 401 questionnaires sent, 228 were returned (57%), indicating wide differences in practice. Of the responders, 50% routinely consider screening in patients with gastro-oesophageal reflux disease, 1/3 for all patients, but 2/3 only for those with long standing reflux disease. Sixty-five percent will diagnose BM using histological criteria by the presence of intestinal metaplasia anywhere in oesophagus. Although the majority (90%) consider surveying patients with known BM using a 4-quadrant protocol, there is considerable variation in the frequency and implementation. Endoscopy intervals also vary in patients with Iow grade dysplasia. Although there is greater agreement in management of patients with high grade dysplasia (HGD), with the majority considering surgery for suitable patients, there was considerable variation in access to pathological expertise and utilisation of this expertise in cases of HGD. The ma ority supported the idea of clinical trials in BM, particularly into the value of surveillance. Conclusion: This survey indicates a wide variation in the management of BM in the UK. This is likely to reflect the lack of good evidence to support one protocol over another and in certain cases a lack of clinical resources, particularly in pathology. There is a clear need for a more robust evidence base on which to base management and direct resources by a large randomised multicentre... [ABSTRACT FROM AUTHOR]