Skip to Main Content

ADENOCARCINOMA OF GASTROESOPHAGEAL JUNCTION

Population

  • –Diagnosis—Barrett’s esophagus with or without gastroesophageal reflux disease. (N Engl J Med. 2014;371:836)

Recommendations

ASGE 2011

  • Follow up of Barrett’s Esophagus

    • No dysplasia—scope every 3 y.

    • Mild dysplasia—scope in 6 mo, then yearly.

    • High-grade dysplasia—surgery or endoscopic therapy. (Gastrointest Cancer Res. 2012;5:49)

Source

  • Gastrointest Endosc. 2006;63:570.

Comments

  1. In 2016, 16,910 Americans diagnosed with esophageal cancer and 15,690 died from this malignancy. Fourfold increase in males compared to females.

  2. Adenocarcinoma most common (4:1 vs. squamous cell CA). Squamous cell cancer most common in African-Americans (6:1).

  3. Risk of adeno CA increases with GERD and high BMI (>30 kg/m2). Squamous cell cancer is related to tobacco use, alcohol, malnutrition, and HPV infection.

  4. Benefits: There is fair evidence that screening would result in no decrease in gastric CA mortality in the United States. Harms: There is good evidence that esophagogastroduodenoscopy (EGD) screening would result in rare but serious side effects, such as perforation, cardiopulmonary events, aspiration pneumonia, and bleeding. (NCI, 2008)

BARRETT ESOPHAGUS (BE)

Populations

  • –General population with gastroesophageal reflux disease (GERD).

  • –High-risk population with GERD (multiple risk factors including age >50, male gender, white, chronic GERD, hiatal hernia, BMI >30, intra-abdominal body fat distribution, or tobacco use).

Recommendations

AGA 2011

  • –Do not screen the general population with GERD for BE.

  • –Strongly consider screening patients with multiple risk factors.

Source

  • Gastroenterology. 2011;140:1084-1091.

Comments

  1. If Barrett’s esophagus is found without dysplasia, follow-up endoscopy in 1 y then every 3–5 y. (JAMA. 2013;310(6):627-636) (Gastroenterology. 2016;151:822)

  2. If low-grade dysplasia is confirmed by endoscopy, eradication therapy is indicated.

  3. If high-grade dysplasia is found, treat with endoscopic eradication rather than esophagectomy. (N Engl J Med. 2014;371:836)

  4. Despite lack of evidence for benefit of screening general population with GERD for BE, endoscopic screening is common and widespread.

  5. Forty percent of patients with BE and esophageal cancer have not had chronic GERD symptoms.

  6. The diagnosis of dysplasia in BE should be confirmed by at least one additional pathologist, preferably one who is an expert in esophageal pathology. (Gastroenterology. 2011;140:1084) (N Engl J Med. 2014;371:836)

  7. All patients with BE should be treated with a protein pump inhibitor even if not symptomatic. (Gut. 2014;63:1229)

CANCER, COLORECTAL (CRC)

Population

  • –Average-risk adults 50–75 y of age.a

Recommendations

AAFP 2018, USPSTF 2017

  • Screen with one of the following strategiesb,c,d

    • Guaiac fecal occult blood test ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.