Mistakes in the endoscopic diagnosis and management of Barrett’s oesophagus and how to avoid them

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Mistakes in the endoscopic diagnosis and management of Barrett’s oesophagus and how to avoid them

Apostolis Papaefthymiou, Cormac Magee, Rehan Jamil Haidry

Summary

AI Generated

This material addresses common mistakes in the endoscopic diagnosis and management of Barrett's oesophagus, the precursor to oesophageal adenocarcinoma, and provides guidance on how to avoid them.

Barrett's oesophagus is the precursor to oesophageal adenocarcinoma, which carries a poor prognosis, and is likely to be encountered by all endoscopists and gastroenterologists in clinical practice.
Endoscopic surveillance and endoscopic endotherapy aim to reduce the risk of progression to invasive adenocarcinoma through careful assessment and management.
Careful multidisciplinary management is important to reduce the risk of causing patients to become unduly concerned.
The material presents common mistakes made in endoscopic diagnosis and management based on the authors' experience and offers advice on avoidance strategies.
This material would be most relevant to endoscopists and gastroenterologists managing patients with Barrett's oesophagus.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

Wani S, Holmberg D, Santoni G, Kauppila JH, Farkkila M, von Euler-Chelpin M, et al. Magnitude and Time-Trends of Post-Endoscopy Esophageal Adenocarcinoma and Post-Endoscopy Esophageal Neoplasia in a Population-Based Cohort Study: The Nordic Barrett’s Esophagus Study. Gastroenterology. 2023 Oct;165(4):909-919.e13. [Link]

Shaheen NJ, Green B, Medapalli RK, Mitchell KL, Wei JT, Schmitz SM, et al. The Perception of Cancer Risk in Patients With Prevalent Barrett’s Esophagus Enrolled in an Endoscopic Surveillance Program. Gastroenterology. 2005 Aug;129(2):429–36. [Link]

Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014 Jan;63(1):7–42. [Link]

Weusten BLAM, Bisschops R, Dinis-Ribeiro M, di Pietro M, Pech O, Spaander MCW, et al. Diagnosis and management of Barrett esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2023 Dec 9;55(12):1124–46. [Link]

Sharma P, Dent J, Armstrong D, Bergman JJGHM, Gossner L, Hoshihara Y, et al. The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus: The Prague C & M Criteria. Gastroenterology. 2006 Nov;131(5):1392–9. [Link]

Visrodia K, Singh S, Krishnamoorthi R, Ahlquist DA, Wang KK, Iyer PG, et al. Magnitude of Missed Esophageal Adenocarcinoma After Barrett’s Esophagus Diagnosis: A Systematic Review and Meta-analysis. Gastroenterology. 2016 Mar;150(3):599-607.e7. [Link]

Gupta N, Gaddam S, Wani SB, Bansal A, Rastogi A, Sharma P. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc. 2012 Sep;76(3):531–8. [Link]

Enestvedt BK, Lugo R, Guarner-Argente C, Shah P, Falk GW, Furth E, et al. Location, location, location: does early cancer in Barrett’s esophagus have a preference? Gastrointest Endosc. 2013 Sep;78(3):462–7. [Link]

Edebo A, Vieth M, Tam W, Bruno M, Van Berkel AM, Stolte M, et al. Circumferential and axial distribution of esophageal mucosal damage in reflux disease. Diseases of the Esophagus. 2007 Jun 1;20(3):232–8. [Link]

10.

Pech O, Gossner L, Manner H, May A, Rabenstein T, Behrens A, et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy. 2007 Jul 5;39(07):588–93. [Link]

11.

Kariyawasam VC, Bourke MJ, Hourigan LF, Lim G, Moss A, Williams SJ, et al. Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett’s esophagus. Gastrointest Endosc. 2012 May;75(5):938–44. [Link]

12.

Sharma P, Bergman JJGHM, Goda K, Kato M, Messmann H, Alsop BR, et al. Development and Validation of a Classification System to Identify High-Grade Dysplasia and Esophageal Adenocarcinoma in Barrett’s Esophagus Using Narrow-Band Imaging. Gastroenterology. 2016 Mar;150(3):591–8. [Link]

13.

Lipman G, Bisschops R, Sehgal V, Ortiz-Fernández-Sordo J, Sweis R, Esteban J, et al. Systematic assessment with I-SCAN magnification endoscopy and acetic acid improves dysplasia detection in patients with Barrett’s esophagus. Endoscopy. 2017 Dec 21;49(12):1219–28. [Link]

14.

Coletta M, Sami SS, Nachiappan A, Fraquelli M, Casazza G, Ragunath K. Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc. 2016 Jan;83(1):57-67.e1. [Link]

15.

Kandiah K, Chedgy FJQ, Subramaniam S, Longcroft-Wheaton G, Bassett P, Repici A, et al. International development and validation of a classification system for the identification of Barrett’s neoplasia using acetic acid chromoendoscopy: the Portsmouth acetic acid classification (PREDICT). Gut. 2018 Dec;67(12):2085–91. [Link]

16.

Meinikheim M, Mendel R, Palm C, Probst A, Muzalyova A, Scheppach MW, et al. Influence of artificial intelligence on the diagnostic performance of endoscopists in the assessment of Barrett’s esophagus: a tandem randomized and video trial. Endoscopy. 2024 Mar 28; [Link]

17.

Jukema JB, Kusters CHJ, Jong MR, Fockens KN, Boers T, van der Putten JA, et al. COMPUTER-AIDED DIAGNOSIS IMPROVES CHARACTERIZATION OF BARRETT’S NEOPLASIA BY GENERAL ENDOSCOPISTS. Gastrointest Endosc. 2024 Apr; [Link]

18.

Tschanz ER. Do 40% of Patients Resected for Barrett Esophagus With High-Grade Dysplasia Have Unsuspected Adenocarcinoma? Arch Pathol Lab Med. 2005 Feb 1;129(2):177–80. [Link]

19.

Beaufort I, Akkerman E, van Munster S, Weusten B. Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis. Endosc Int Open. 2023 Mar 8;11(03):E221–9. [Link]

20.

Beaufort IN, Milne AN, Alderlieste YA, Baars JE, Bos PR, Burger JPW, et al. Adherence to guideline recommendations for Barrett’s esophagus (BE) surveillance endoscopies: Effects of dedicated BE endoscopy lists. Endosc Int Open. 2023 Oct 11;11(10):E952–62. [Link]

21.

Duits LC, Phoa KN, Curvers WL, ten Kate FJW, Meijer GA, Seldenrijk CA, et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut. 2015 May;64(5):700–6. [Link]

22.

Visrodia K, Zakko L, Singh S, Leggett CL, Iyer PG, Wang KK. Cryotherapy for persistent Barrett’s esophagus after radiofrequency ablation: a systematic review and meta-analysis. Gastrointest Endosc. 2018 Jun;87(6):1396-1404.e1. [Link]

23.

El-Serag HB, Naik AD, Duan Z, Shakhatreh M, Helm A, Pathak A, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016 Aug;65(8):1252–60. [Link]

24.

Kastelein F, van Olphen SH, Steyerberg EW, Spaander MCW, Bruno MJ. Impact of surveillance for Barrett’s oesophagus on tumour stage and survival of patients with neoplastic progression. Gut. 2016 Apr;65(4):548–54. [Link]

Abstract

Barrett’s oesophagus is the precursor to oesophageal adenocarcinoma, which carries a poor prognosis, and it is likely that all endoscopists and gastroenterologists will encounter Barrett’s oesophagus in their clinical practice. Careful assessment and management of patients who have Barrett’s oesophagus with endoscopic surveillance and endoscopic endotherapy aim to reduce the risk of progression to invasive adenocarcinoma. Advances in endoscopic diagnosis and therapy should, therefore, help to reduce the risk of progression. As with all premalignant conditions and surveillance programmes, careful multidisciplinary management of the patient is important to reduce the risk of causing them to become unduly concerned. Here, we present some mistakes that in our experience are commonly made in the endoscopic diagnosis and management of Barrett’s oesophagus and give advice on how to avoid them.

Topics

Endoscopy Oesophagus

Citation

Haidry RJ and Magee C. Mistakes in the endoscopic diagnosis and management of Barrett’s oesophagus and how to avoid them. UEG Education 2018; 2018: 12–14.

Published

2024

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Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

10.

11.

12.

13.

14.

15.

16.

17.

18.

Tschanz ER. Do 40% of Patients Resected for Barrett Esophagus With High-Grade Dysplasia Have Unsuspected Adenocarcinoma? Arch Pathol Lab Med. 2005 Feb 1;129(2):177–80. [Link]

19.

20.

21.

22.

23.

24.

Abstract

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

Topics

Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

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UEG Standards and Guidelines

Consensus

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Third N-ECCO Consensus Statements on the Nursing Roles in Caring for Patients with Inflammatory Bowel Disease

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Guideline

Introduction

The Nurses Committee of the European Crohn’s and Colitis Organisation (N-ECCO) is an active Committee of the ECCO that aims to improve access to nurse education in inflammatory bowel disease (IBD) throughout Europe and to provide a link with national nursing networking organisations. The first N-ECCO Consensus Statements were published in 2013 and sought to identify the positioning of nurses in the care of patients with IBD and to provide a consensus on the ideal standard of minimum care that patients with IBD might expect. The first update was made in 2018. The N-ECCO Consensus Statements have been widely distributed internationally, guiding IBD centers and IBD nurses to establish the most optimal quality of care in IBD. High-quality IBD care requires working within a multidisciplinary team (MDT). Core team members should include at least one IBD nurse, a gastroenterologist, a colorectal surgeon, a radiologist, and a dietitian. In this MDT, the IBD nurse has a clear role as coordinator between the patient and the different disciplines, with the objective of providing a holistic approach to care.¹^,² In addition to administering and monitoring treatments, IBD nurses provide education, support, counselling, and advocacy for patients. Even if the role of the IBD nurse has become more established in recent years, several differences between countries remain, including variations in education and role. In the two previous N-ECCO Consensus Statements, the statements were divided into fundamental and advanced IBD nursing. Due to the different conditions across countries, this division was removed in this update.

The overall aim of ECCO is to improve the care of patients with IBD through development of guidelines, education, and research. The N-ECCO Consensus Statements seek to realise this aim from an IBD nursing perspective, by providing statements and evidence to guide and ensure the ideal standard of care.³^,⁴ This third update aims to provide a framework for IBD nurses to continue delivering high-quality and evidence-based care, to consider the needs of diverse patient populations, and to include new technical tools.

Publisher

European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7

Published

2026

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

10.

11.

12.

13.

14.

15.

16.

17.

18.

Tschanz ER. Do 40% of Patients Resected for Barrett Esophagus With High-Grade Dysplasia Have Unsuspected Adenocarcinoma? Arch Pathol Lab Med. 2005 Feb 1;129(2):177–80. [Link]

19.

20.

21.

22.

23.

24.

Abstract

Long-term enteral nutrition via gastrostomy is a relatively common medical intervention for patients at risk of malnutrition who have an accessible and functioning gastrointestinal tract. There are clear clinical guidelines describing the principles of practice as well as numerous retrospective and non-randomised controlled studies and case series. However, fewer publications impart advice and guidance regarding the management and ‘patient selection’ for these interventions. The following article provides a combination of the author’s views and the evidence base.

Topics

Small Intestine & Nutrition Stomach & H. Pylori

Citation

Welbank T, Mistakes in gastrostomy insertion ingestion and how to avoid them. UEG Education 2024; 24: 8-11.

Published

2024

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