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      Combined EsophaCap cytology and MUC2 immunohistochemistry for screening of intestinal metaplasia, dysplasia and carcinoma

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          Abstract

          Purpose: The incidence of esophageal adenocarcinoma (EAC) has increased by 700% in Western countries over the last 30 years. Although clinical guidelines call for endoscopic surveillance for EAC among high-risk populations, fewer than 5% of new EAC patients are under surveillance at the time of diagnosis. We studied the accuracy of combined cytopathology and MUC2 immunohistochemistry (IHC) for screening of Intestinal Metaplasia (IM), dysplasia and EAC, using specimens collected from the EsophaCap swallowable encapsulated cytology sponge from Canada and United States.

          Patients and methods: By comparing the EsophaCap cytological diagnosis with concurrent endoscopic biopsies performed on the same patients in 28 cases, we first built up the cytology diagnostic categories and criteria. Based on these criteria, 136 cases were evaluated by both cytology and MUC2 IHC with blinded to patient biopsy diagnosis.

          Results: We first set up categories and criteria for cytological diagnosis of EscophaCap samples. Based on these, we divided our evaluated cytological samples into two groups: non-IM group and IM or dysplasia or adenocarcinoma group. Using the biopsy as our gold standard to screen IM, dysplasia and EAC by combined cytology and MUC2 IHC, the sensitivity and specificity were 68% and 91%, respectively, which is in the range of clinically useful cytological screening tests such as the cervical Pap smear.

          Conclusions: Combined EsophaCap cytology and MUC2 IHC could be a good screening test for IM and Beyond.

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          Esophageal adenocarcinoma incidence: are we reaching the peak?

          H. Welch, Brenda Sirovich, Carolina H Pohl (2010)
          A steep increase in the incidence of esophageal adenocarcinoma has been observed between 1973 and 2001, but recent trends have not been reported. Our aim was to examine recent trends in esophageal adenocarcinoma incidence. We used the Surveillance Epidemiology and End Results database of the National Cancer Institute to identify all patients who were diagnosed with esophageal adenocarcinoma between 1973 and 2006. Incidence trends were analyzed for esophageal adenocarcinoma overall and by stage using joinpoint regression. Overall esophageal adenocarcinoma incidence increased from 3.6 per million in 1973 to 25.6 per million in 2006. Incidence trend analysis, however, suggests that the increase has slowed, from an 8.2% annual increase prior to 1996 to 1.3% increase in subsequent years (P = 0.03). Stage-specific trend analyses suggest that the change in overall esophageal adenocarcinoma incidence largely reflects a plateau in the incidence of early stage disease. Its slope has changed direction, from a 10% annual increase prior to 1999 to a 1.6% decline in subsequent years (P = 0.01). The incidence of early stage esophageal adenocarcinoma seems to have plateaued. Although definitive conclusions will require additional years of data, the plateau in early stage disease might portend stabilization in the overall incidence of esophageal adenocarcinoma. Copyright 2010 AACR.
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            Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015.

            Yoshikazu Kinoshita, Katsuhiko Iwakiri (2016)
            As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett's esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedance-pH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.
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              Screening for Barrett's esophagus in colonoscopy patients with and without heartburn.

              Oscar W. Cummings, D Helper, R Vasudeva … (2003)
              The population prevalence of Barrett's esophagus (BE) is uncertain. Our aim was to describe the prevalence of BE in a volunteer population. Upper endoscopy (EGD) was performed in 961 persons with no prior history of EGD who were scheduled for colonoscopy. Symptom questionnaires were completed prior to endoscopy. Biopsy specimens were taken from the gastric cardia and any columnar mucosa extending > or =5 mm into the tubular esophagus and from the stomach for H. pylori infection in the last 812 patients. The study sample was biased toward persons undergoing colonoscopy, males, and persons with upper GI symptoms. The prevalence of BE was 65 of 961 (6.8%) patients, including 12 (1.2%) with long-segment BE (LSBE). Among 556 subjects who had never had heartburn, the prevalences of BE and LSBE were 5.6% and 0.36%, respectively. Among 384 subjects with a history of any heartburn, the prevalences of BE and LSBE were 8.3% and 2.6%, respectively. In a univariate analysis, LSBE was more common in those with any heartburn vs. those with no heartburn (P = 0.01), but the sample size was insufficient to allow multivariate analysis of predictors of LSBE. In a multivariate analysis, BE was associated with increasing age (P = 0.02), white race (P = 0.03), and negative H. pylori status (P = 0.04). Overall, BE was not associated with heartburn, although heartburn was more common in persons with LSBE or circumferential short segments. LSBE is very uncommon in patients who have no history of heartburn. SSBE is relatively common in persons age > or =40 years with no prior endoscopy, irrespective of heartburn history.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Exp Gastroenterol
                Journal ID (iso-abbrev): Clin Exp Gastroenterol
                Journal ID (publisher-id): CEG
                Journal ID (pmc): ceg
                Title: Clinical and Experimental Gastroenterology
                Publisher: Dove
                ISSN (Electronic): 1178-7023
                Publication date (Electronic): 15 May 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 219-229
                Affiliations
                [1 ]Department of Pathology & Immunology, Washington University , Saint Louis, MO, USA
                [2 ]Department of Adaptive Oncology, Ontario Institute for Cancer Research , Toronto, Ontario, Canada
                [3 ]Division of Gastroenterology, Department of Internal Medicine, St. Michael’s Hospital , Toronto, Ontario, Canada
                [4 ]Department of Statistics, George Washington University , Washington, DC, USA
                [5 ]Department of Surgery, Boston University School of Medicine , Boston, MA, USA
                Author notes
                Correspondence: Zhongren ZhouDepartment of Pathology and Immunology, Washington University , 660 South Euclid Campus Box 8118, Saint Louis, MO63110-1093, USATel +1 314 747 1397Fax +1 314 362 4096Email zhongrenzhou@ 123456wustl.edu
                Article
                Publisher ID: 186958
                DOI: 10.2147/CEG.S186958
                PMC ID: 6527096
                SO-VID: dca80f20-7bcd-49b0-8815-7828b2e45519
                Copyright © © 2019 Zhou et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 09 September 2018
                Date accepted : 30 March 2019
                Page count
                Figures: 4, Tables: 4, References: 40, Pages: 11
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: barrett’s esophagus,esophageal adenocarcinoma,cytology screening,muc2 ihc,esophacap,intestinal metaplasia
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: barrett’s esophagus, esophageal adenocarcinoma, cytology screening, muc2 ihc, esophacap, intestinal metaplasia

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