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

2 Wani_Risk stratification and selection is key for BE ablation

Pdf Summary

Risk stratification and selection are crucial in determining the appropriate approach for ablation in patients with Barrett's esophagus (BE). Ablating all patients with non-dysplastic BE may not be necessary as the risk of cancer is low and there is limited evidence that it reduces that already low risk. Additionally, the adverse events associated with endoscopic eradication therapy (EET) and the high number needed to treat (NNT) make it cost-ineffective. In the case of BE with low-grade dysplasia (LGD), there are challenges in management due to high interobserver variability among pathologists, variable natural history, the phenomenon of regression, and the lack of well-defined risk stratification tools. However, studies have shown that ablating LGD reduces the risk of progression to higher grades of dysplasia and esophageal adenocarcinoma. Guidelines suggest considering EET over surveillance for LGD, but individual patient preferences should be taken into account. There are gaps in evidence regarding the neoplastic progression rates, mortality impact of EET, and quality of life outcomes. Several risk stratification tools have been proposed, including clinical variables, TP53 mutations, tissue system pathology tests, and aneuploidy detection. However, further validation and prospective trials are needed to assess their performance and determine their suitability for different patient populations. The SURVENT trial is a multicenter randomized controlled trial currently underway to compare surveillance with EET in patients with BE and LGD. The study aims to validate biomarkers and further improve risk stratification. In conclusion, risk stratification and selection are essential in determining the appropriate approach for ablation in BE, taking into account patient preferences and utilizing validated risk stratification tools.

Keywords

Risk stratification

ablation

Barrett's esophagus

endoscopic eradication therapy

high-grade dysplasia

esophageal adenocarcinoma

risk stratification tools

neoplastic progression rates

clinical variables

SURVENT trial