Nicholas R. Crews

Comparative quality assessment of esophageal examination with transnasal and sedated endoscopy

Background Unsedated transnasal esophagoscopy (TNE) may offer a less expensive, mobile alternative to sedated esophagogastroduodenoscopy (EGD) for evaluations of reflux related complications. Comparisons of imaging quality by these methods are lacking. Methods Two reviewers evaluated videos of TNE and EGD procedures, performed during a community randomized study comparing endoscopic techniques. Subjects were randomized to EGD, TNE in endoscopy suite, or TNE in mobile research unit. Endoscopic quality was assessed using a validated scoring tool. Results In total, 115 videos (58 EGD, 28 endoscopy suite TNE, and 29 mobile TNE) were reviewed. Overall quality scores for TNE and EGD were excellent without a statistically significant difference (P = 0.30). There were no differences in gastroesophageal junction (GEJ) visualization scores, though EGD scored higher in esophageal passage (P < 0.05) and TNE scored higher in esophageal intubation (P < 0.05). There was no significant difference in any quality score between mobile TNE and gastrointestinal suite TNE. Conclusion Esophageal assessment with TNE or EGD was comparable in overall quality and GEJ visualization. TNE quality was not affected by procedure location. TNE is a feasible option for endoscopic assessment of reflux complications.

Persistence of Nondysplastic Barrett’s Esophagus Is Not Protective Against Progression to Adenocarcinoma

© 2017 by the AGA Institute 1542-3565/

Sa1074 Increased Number of Risk Factors Predicts Esophageal Injury and Metaplasia: Results From a Large Prospective Population-Based Study

36.00 http://dx.doi.org/10.1016/j.cgh.2017.02.019 Bfactor for esophageal adenocarcinoma (EAC). Gastrointestinal societies recommend endoscopic surveillance in patients with BE to enable early detection of dysplasia and malignancy. Recently, Gaddam et al have reported that persistence of nondysplastic BE (NBDE) on repeated biopsies predicts lower risk of progression, suggesting that these patients could undergo less intensive surveillance. Conversely, there is also evidence suggesting that the risk of progression in BE continues to increase over time. Therefore, we aimed to investigate if persistence of NBDE in consecutive surveillance biopsies reduces the risk of progression to EAC, providing justification for prolonging surveillance intervals.

Sa1067 Rates and Predictors of Progression in Barrett's Esophagus With Low Grade Dysplasia: Results From a Prospective U.S. Registry

modalities were included in this analysis. Patients who stopped EET and started surveillance prior to CE-IM were excluded. Complete eradication of intestinal metaplasia (CE-IM) was defined as having an endoscopy with no visible columnar lined epithelium in the tubular esophagus and biopsies of the neo-squamous mucosa showing no intestinal metaplasia. Patients were considered to have achieved CE-IM if they had done so with 2cm were less likely to achieve CE-IM compared to those with C extents ≤2cm (64.3% vs. 73.5%, p=0.027). Patients with M extents of > 3cm were less likely to achieve CE-IM compared to those with M extents ≤3cm (61.2% vs. 88.4%, p<0.001). Conclusions: Results of this multi-center effectiveness trial show that pre-treatment Barretts esophagus extent as measured by the Prague criteria is associated with the rate of achieving CE-IM with endoscopic eradication therapy. This was true for both the C and M extents of disease. This study provides the first validation of the Prague criteria with clinically relevant outcomes in the management of patients with Barretts esophagus.

Prevalence and Predictors of Gastroesophageal Reflux Complications in Community Subjects

BACKGROUND Estimates of progression in BE-LGD are limited by heterogeneity in pathological diagnoses. While recent data show that ablation in BE-LGD reduces risk of progression to HGD/EAC, they are limited by high rates of progression not seen in most studies. Identification of risk factors for progression in BE-LGD may help in selecting subjects for endoscopic therapy. We aimed to assess the rates and predictors of progression in a cohort of BE-LGD subjects who were part of a large prospective BE-EAC registry in a tertiary care center. METHODS Subjects with a histologic diagnosis of LGD (made by expert GI pathologists) were identified from a prospective BE registry at our institution. The registry database has records of demographic details, endoscopic findings and histologic data from esophageal biopsies. Index date was defined as the first date of LGD diagnosis. Progressors were defined as BE-LGD subjects who developed HGD / EAC more than 12 months after the index date. Risk factors assessed included demographic variables, family history of BE/ EAC, GERD symptoms, duration of BE, medication use, endoscopic findings and histological findings (multifocal vs unifocal LGD, H pylori status in gastric biopsy). Univariate and multivariable analyses were performed to identify predictors of progression using Cox Proportional Hazards models. RESULTS 353 BE-LGD subjects were identified, of which 337 were included after excluding those with missing data. The mean (SD) age of these subjects was 63.2 (11.2) years. 283 (84 %) were males. Baseline characteristics are summarized in table 1. Of the 337 BE-LGD patients, 21 (6.2 %) subjects progressed to HGD / EAC. The mean (SD) follow up of subjects was 7 (5) years. The annual incidence of HGD/EAC in subjects with BE-LGD was 0.8%. Univariate and multivariable predictors of progression to HGD/ EAC are presented in table 2. On univariate analysis, longer BE segment length and presence of nodularity increased risk of progression, while a longer follow up duration after LGD diagnosis reduced the risk of progression. Multifocal dysplasia (dysplasia at multiple levels) approached statistical significance as a predictor of progression. On multivariable analysis, increased BE segment length remained a predictor of progression while older age and longer LGD follow up (likely reflecting persistent LGD) reduced the risk of progression. CONCLUSIONS: In this well-defined cohort of BE-LGD patients with all histology confirmed by expert GI pathologists, progression rates for LGD subjects were substantially lower than those reported in some European studies. Longer BE segment length and younger age at LGD diagnosis predicted a higher risk of progression. These subjects may be candidates for intensive surveillance or endoscopic therapy.