ASGE Annual GI Advanced Practice Provider Course (Virtual) - Day Two | April 2022-21_Barretts Esophagus_Endotherapy

21_Barretts Esophagus_Endotherapy - Kaul

Pdf Summary

The ASGE Annual Advanced Practice Provider (APP) Course 2022 will cover Barrett's Esophagus Endotherapy, presented by Dr. Vivek Kaul from the University of Rochester Medical Center. The objectives of the course are to identify which patients with Barrett's esophagus should be treated, differentiate which patients can be effectively treated with endoscopic therapy versus surgery, and review the limitations of current therapeutic regimens.<br /><br />Barrett's Esophagus is defined as the presence of at least 1cm of Columnar Lined Epithelium (CLE) with specialized intestinal metaplasia (SIM), characterized by goblet cell metaplasia. It is a precancerous condition with an annual risk of progression to esophageal adenocarcinoma of 0.3% per year.<br /><br />The natural history of Barrett's Esophagus includes stages such as non-dysplastic Barret's Esophagus, indefinite for dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), intra-mucosal carcinoma (ImCa, T1a), invasive carcinoma (T1b and higher stage), locally advanced carcinoma, and metastatic carcinoma.<br /><br />The decision to treat Barrett's Esophagus depends on the presence or absence of dysplasia and the stage of the disease. Surveillance is recommended for patients with indefinite for dysplasia, LGD, and non-dysplastic Barrett's Esophagus. Endoscopic eradication therapy (EET) is indicated for patients with LGD, HGD, T1a esophageal adenocarcinoma, and potentially T1b SM1 esophageal adenocarcinoma. Surgery is considered for patients with T1b SM1 esophageal adenocarcinoma or worse pathology.<br /><br />Management of LGD involves determining the need for ablation therapy versus surveillance based on certain factors such as confirmation by an expert pathologist, family history, comorbidities/age, persistent or multifocal LGD, and shared decision-making.<br /><br />Endoscopic eradication therapy includes various techniques such as endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), cryoablation, and endoscopic submucosal dissection (ESD). These therapies aim to resect all visible lesions and ablating residual Barrett's epithelium to achieve complete eradication of dysplasia and intestinal metaplasia.<br /><br />Radiofrequency ablation (RFA) is a commonly used technique that involves the obliteration of dysplastic Barrett's tissue using bipolar energy. It is fast, reproducible, and has a relatively low stricture rate. Cryotherapy is another ablation modality that uses liquid nitrogen spray to induce mucosal destruction of the tumor. It is well-tolerated and effective for early esophageal adenocarcinoma.<br /><br />Surveillance after endoscopic eradication therapy is crucial to detect any recurrence of Barrett's or dysplasia. Patients who achieve complete eradication of intestinal metaplasia require close and ongoing surveillance. The role of APPs in Barrett's practice includes initial evaluation, periprocedure management support, participation in GI tumor boards, and adherence to screening and surveillance guidelines.<br /><br />In summary, the ASGE Annual APP Course 2022 will cover the management of Barrett's Esophagus, including the indications for treatment, the different endoscopic therapy modalities, the importance of surveillance, and the role of APPs in the management of Barrett's Esophagus patients.

Keywords

ASGE Annual APP Course 2022

Barrett's Esophagus Endotherapy

Endoscopic therapy

Surgery

Therapeutic regimens

Esophageal adenocarcinoma

Dysplasia

Endoscopic eradication therapy

Radiofrequency ablation

Role of APPs