ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy | October 2022-2 Wani_Risk stratification and selection is key for BE ablation

2 Wani_Risk stratification and selection is key for BE ablation

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This document discusses risk stratification and selection as key factors for Barrett's esophagus ablation. The document begins by questioning whether all patients with non-dysplastic Barrett's esophagus should be ablated, highlighting the low risk of cancer and lack of evidence supporting ablation. It also mentions the high adverse event rate associated with ablation and the limited data on durability. The document argues that ablation for non-dysplastic Barrett's esophagus is not cost-effective.<br /><br />The document then addresses the challenges in managing Barrett's esophagus with low-grade dysplasia (LGD), including high interobserver variability among pathologists and the variable natural history of LGD. It discusses studies that have shown the benefits of ablation in reducing the risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC).<br /><br />Next, the document highlights the gaps in evidence, including conflicting data on mortality and the impact of endoscopic eradication therapy (EET) on neoplastic progression. It also mentions the phenomenon of regression and the lack of well-defined risk stratification tools and biomarkers. The document provides guidelines for EET in patients with LGD, suggesting that it may be preferred over surveillance but should be decided based on patient preferences.<br /><br />The document discusses the flawed practices in surveillance and introduces the concepts of Post-endoscopy Esophageal Neoplasia (PEEN) and Post-endoscopy Esophageal Adenocarcinoma (PEEC). It then presents a ten-step approach to high-quality examination and emphasizes the importance of advanced sampling techniques.<br /><br />The document explores various risk stratification approaches, including clinical variables, TP53 mutations, tissue systems pathology tests, and the Barrett's Aneuploidy Decision (BAD). It also mentions ongoing research for validating biomarkers and the future directions for improved risk stratification.<br /><br />Finally, the document introduces the SURVENT trial, a multicenter randomized controlled trial comparing surveillance to EET in patients with Barrett's esophagus and LGD. The document concludes with a thank you note.

Keywords

risk stratification

Barrett's esophagus ablation

non-dysplastic Barrett's esophagus

adverse events

low-grade dysplasia

esophageal adenocarcinoma

endoscopic eradication therapy

neoplastic progression

surveillance

biomarkers