ArticleUnited European gastroenterology journal2024
Expert assessment of infiltration depth and recommendation of endoscopic resection technique in early Barrett cancer.
Article in United European gastroenterology journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Diagnostic Accuracy of Optical Endoscopic Evaluation and EUS for Differentiating T1a and T1b Barrett's Adenocarcinoma: A Systematic Review and Meta-Analysis.Digestive diseases and sciences · 2026Pooled it
- Review
- Cancer Burden on Piecemeal Endoscopic Resection of Early Adenocarcinoma in Barrett's Oesophagus Correlates With the Risk of Neoplastic Recurrence.United European gastroenterology journal · 2025Article
- Expert assessment of infiltration depth and recommendation of endoscopic resection technique in early Barrett cancer.United European gastroenterology journal · 2024Article
- Can endoscopists judge a book by its cover when it comes to Barrett cancer?United European gastroenterology journal · 2024Article
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13 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly Barrett cancer can be curatively treated by endoscopic resection. The choice of the resection technique, however-endoscopic mucosal resection (EMR) or submucosal dissection (ESD)-largely depends on the assumed infiltration depth as judged by the endoscopist. However, the accuracy of endoscopic diagnosis of the degree of cancer infiltration is not known.
methodsThree to four high-quality images (both in overview and close-up) from 202 of early Barrett esophagus cancer cases (82% men, mean age 66.9 years) were selected from our endoscopy database (73.3% stage T1a and 26.7% in stage T1b). Images were shown to 9 Barrett esophagus experts, with patients' clinical data (age, sex, Barrett esophagus length) and biopsy results. The experts were asked to predict infiltration depth (T1b vs. T1a), and to suggest the appropriate endoscopic resection technique (EMR or ESD, or surgery). Interobserver variability (kappa values) was also determined for these parameters.
resultsOverall positive (PPV) and negative predictive values (NPV) to diagnose T1b versus T1a infiltration were 40.7% (95% CI: 36.7, 44.8) and 79.8% (95% CI: 77.5, 81.9), respectively; kappa value was 0.41. Paris classification (kappa 0.51) and suggested treatment also varied between experts. In a post hoc analysis, only the correlation between lesions classified as invisible or flat according to the Paris classification (IIB; 25% of all cases) and the suggested resection technique was better: In this subgroup, EMR was recommended in >80% of cases, with a high complete (basal R0) resection rate (mean of 88.1%).
conclusionsPrecise endoscopic distinction between mucosal and submucosal involvement of Barrett esophagus cancer by experts as a basis for choosing the resection technique has limited predictive values and high interobserver variability. It seems that mainly invisible/flat lesions may result in good resection outcomes when treated by EMR, but this stratification strategy has to be assessed in further studies.
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