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This article discusses the additional value of expert care for patients with ultra-long Barrett's Esophagus (BE) in the Netherlands. The study evaluated the findings of imaging endoscopy performed at a Barrett Expert Center (BEC) for patients with ultra-long segment BE. The results showed that upon referral to a BEC, 19% of patients were upstaged from no dysplasia to BE with dysplasia or cancer. The study suggests that expert care may be beneficial for the high-risk population with ultra-long BE. [Extracted from the article]

This article discusses the detection of early neoplasia in patients with Barrett's esophagus (BE) through endoscopic surveillance programs. The study analyzed data from the Dutch Barrett Expert Center Registry and found that only half of the patients with early Barrett's neoplasia were diagnosed through surveillance programs, while the other half were diagnosed with synchronous neoplasia. The proportion of patients with synchronous neoplasia increased with more severe histology at the time of treatment. These findings raise questions about the efficacy and cost-effectiveness of BE surveillance. [Extracted from the article]

This article discusses a randomized clinical trial comparing different biopsy techniques for patients with Barrett's Esophagus (BE). The study compared the double-biopsy method to the single-biopsy method, as well as the advance-and-close technique to the turn-and-suction technique. The primary endpoint of the study was the size of biopsy specimens, and secondary endpoints included factors such as the presence of muscularis mucosae, biopsy orientation, and biopsy time. The results showed that the single-biopsy method resulted in larger biopsy sizes and better biopsy orientation compared to the double-biopsy method. However, there were no significant differences in biopsy quality between the advance-and-close and turn-and-suction techniques. Overall, the study suggests that using the single-biopsy method can improve biopsy size and orientation in BE patients. [Extracted from the article]

Introduction: After endoscopic resection (ER) of neoplasia in Barrett's esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status.Methods: Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality.Results: Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11-51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC.Conclusion: In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation. [ABSTRACT FROM AUTHOR]

Background and study aims: The clinical utility of narrow-band imaging (NBI) for Barrett's esophagus is limited by the multiplicity of classification schemes. We evaluated the interobserver agreement and accuracy of a new consensus-driven simplified binary classification of NBI surface patterns. Patients and methods: NBI images from macroscopically normal areas in patients with Barrett's esophagus were retrieved from endoscopy databases and were randomized for review by seven endoscopists (three experts, four nonexperts). A simplified binary classification of NBI mucosal and vascular patterns was used: (1) regular pattern (nondysplastic Barrett's esophagus); (2) irregular pattern (dysplastic Barrett's esophagus). Agreement in relation to surface patterns and predicted histology (dysplasia vs. no dysplasia) was calculated using κ statistics. Results: A total of 252 NBI images from 75 patients with Barrett's esophagus were assessed: 93 showed intestinal metaplasia, 91 low-grade dysplasia, and 68 high-grade dysplasia/esophageal adenocarcinoma. The median score for image quality was 4 (very good). Interobserver agreement for mucosal and vascular patterns and dysplasia prediction was fair: κ = 0.40 (95%CI: 0.37-0.42), 0.36 (95%CI: 0.33-0.38), and 0.39 (95%CI: 0.36-0.41) respectively, with comparable results for experts and nonexperts. Intraobserver agreement was substantially better among experts than among nonexperts, with mucosal κ = 0.63 vs. 0.49, vascular κ = 0.58 vs. 0.43, and predicted histology κ = 0.68 vs. 0.54 (all P < 0.005). Mean sensitivity and specificity of NBI surface patterns for predicting dysplasia were 47% (95%CI: 44%-55%) and 72% (95%CI: 69%-76%) respectively. Conclusions: Using a consensus-driven simplified classification of NBI surface patterns for Barrett's esophagus, the interobserver agreement was fair with suboptimal sensitivity and specificity. Significant improvements in NBI interpretation are needed prior to the routine use of NBI surface patterns for the assessment of Barrett's esophagus. [ABSTRACT FROM AUTHOR]