Barrett's esophagus : emerging evidence for improved clinical practice

219 Pages·2016·18.268 MB·English

by  Erim, Tolga, Pleskow, Douglas K

BARRETT’S ESOPHAGUS
BARRETT’S
ESOPHAGUS
Emerging Evidence for Improved
Clinical Practice
Editedby
Douglas K. Pleskow
Chief,ClinicalGastroenterology,BethIsraelDeaconessMedicalCenter
AssociateClinicalProfessorofMedicine,HarvardMedicalSchool
Boston,MA,UnitedStates
Tolga Erim
DirectorofEndoscopy,DepartmentofGastroenterology,DigestiveDiseaseCenter,ClevelandClinicFlorida,
Weston,FL,UnitedStates
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Dedication
Iwouldliketodedicatethistomyfamily.
MydaughtersSara,Heather,andRebeccafortheirloveanddedication.
MywifeRandiPleskow,MD,forherloveandaffectionandalwaysstandingbymyside.
—DouglasK.Pleskow
ForViviana,howluckyIamtoshareeverydaywithyou.
—TolgaErim
List of Contributors
Kamar Belghazi Department of Gastroenterology Rebecca C. Fitzgerald Medical Research Council
and Hepatology, Academic Medical Center, Cancer Unit, University of Cambridge,
Amsterdam,TheNetherlands Cambridge,UnitedKingdom
Jacques J. Bergman Department of Gastroen- Alexander M. Frankell Medical Research Council
terology and Hepatology, Academic Medical Cancer Unit, University of Cambridge,
Center,Amsterdam,TheNetherlands Cambridge,UnitedKingdom
Tyler M. Berzin Division of Gastroenterology, Martin Goetz Innere Medizin I, Universita¨tsk-
Center for Advanced Endoscopy, Department of linikumTu¨bingen,Tu¨bingen,Germany
Medicine, Beth Israel Deaconess Medical Center, Jeffrey D. Goldsmith Department of Pathology,
HarvardMedicalSchool,Boston,MA,UnitedStates Beth Israel Deaconess Medical Center, Harvard
Kathryn Boom Department of Surgery, Houston MedicalSchool,Boston,MA,UnitedStates
MethodistHospital,Houston,TX,UnitedStates Michalina J. Gora Wellman Center for
Amitabh Chak Advanced Technology & Photomedicine, Massachusetts General Hospital,
Innovation Center of Excellence, Division of Boston, MA, United States; ICube
Gastroenterology, Case Western Reserve Laboratory, Centre National de la Recherche
University,Cleveland,OH,UnitedStates Scientifique, University of Strasbourg, Strasbourg,
Ram Chuttani Center for Advanced Endoscopy, France
Department of Medicine, Beth Israel Deaconess Jennifer T. Higa Department of Medicine,
MedicalCenter,HarvardMedicalSchool,Boston, University of Washington School of Medicine,
MA,UnitedStates Seattle,WA,UnitedStates
Yas¸ar C¸olak Department of Gastroenterology, Joo Ha Hwang Gastroenterology Section, Harbor-
Go¨ztepeEducationandResearchHospital,Istanbul view Medical Center, University of Washington
MedeniyetUniversity,Kadiko¨y,Istanbul,Turkey SchoolofMedicine,Seattle,WA,UnitedStates
John A. Dumot University Hospitals Digestive Irving Itzkan Center for Advanced Biomedical
Health Institute, Case Western Reserve Imaging and Photonics, Department of ObGyn
University, Cleveland, OH, United States; and Reproductive Biology, Beth Israel Deaconess
University Hospitals Ahuja Medical Center, MedicalCenter,HarvardMedicalSchool,Boston,
Beachwood,OH,UnitedStates MA,UnitedStates
Brian J. Dunkin Section of Endoscopic Surgery, Annalise C. Katz-Summercorn Medical Research
Institute for Academic Medicine, Houston Council Cancer Unit, University of Cambridge,
Methodist Hospital, Houston, TX, United States; Cambridge,UnitedKingdom
Department of Surgery, Houston Methodist Umar Khan Center for Advanced Biomedical
Hospital,Houston,TX,UnitedStates Imaging and Photonics, Department of ObGyn
Tolga Erim Department of Gastroenterology, and Reproductive Biology, Beth Israel Deaconess
Digestive Disease Center, Cleveland Clinic MedicalCenter,HarvardMedicalSchool,Boston,
Florida,Weston,FL,UnitedStates MA,UnitedStates
xi
xii
LISTOFCONTRIBUTORS
Gaurav Kistangari Department of Internal EbubekirS¸enates¸ DepartmentofGastroenterology,
Medicine, Cleveland Clinic, Cleveland, OH, Go¨ztepe Education and Research Hospital,
UnitedStates IstanbulMedeniyetUniversity,Istanbul,Turkey
Deepa T. Patil Cleveland Clinic Lerner College of Guillermo J. Tearney Wellman Center for
Medicine, Cleveland, OH, United States; Photomedicine, Massachusetts General Hospital,
Department of Pathology, Robert J. Tomsich Boston, MA, United States; Department of
Pathology and Laboratory Medicine Institute, Pathology, Massachusetts General Hospital,
ClevelandClinic,Cleveland,OH,UnitedStates Boston, MA, United States; Harvard-MIT
Lev T. Perelman Center for Advanced Biomedical Division of Health Sciences and Technology,
Imaging and Photonics, Department of ObGyn Boston,MA,UnitedStates
and Reproductive Biology, Beth Israel Deaconess Prashanthi N. Thota Center of Excellence for
MedicalCenter,HarvardMedicalSchool,Boston, Barrett’sEsophagus,DepartmentofGastroentero-
MA, United States; Center for Advanced logy and Hepatology, Cleveland Clinic,
Endoscopy, Department of Medicine, Beth Israel Cleveland,OH,UnitedStates
Deaconess Medical Center, Harvard Medical George Triadafilopoulos Stanford University
School,Boston,MA,UnitedStates SchoolofMedicine,Stanford,CA,UnitedStates
Douglas K. Pleskow Clinical Gastroenterology, Vladimir Turzhitsky Center for Advanced
Beth Israel Deaconess Medical Center, Boston, Biomedical Imaging and Photonics, Department
MA, United States; Center for Advanced of ObGyn and Reproductive Biology, Beth Israel
Endoscopy, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical
Deaconess Medical Center, Harvard Medical School,Boston,MA,UnitedStates
School,Boston,MA,UnitedStates
Edward Vitkin Center for Advanced Biomedical
AmareshwarPodugu DepartmentofGastroentero- Imaging and Photonics, Department of ObGyn
logy, Digestive Disease Center, Cleveland Clinic and Reproductive Biology, Beth Israel Deaconess
Florida,Weston,FL,UnitedStates MedicalCenter,HarvardMedicalSchool,Boston,
Roos E. Pouw Department of Gastroenterology MA,UnitedStates
and Hepatology, Academic Medical Center, Fen Wang Center for Advanced Endoscopy,
Amsterdam,TheNetherlands Department of Medicine, Beth Israel Deaconess
Le Qiu Center for Advanced Biomedical Imaging MedicalCenter,HarvardMedicalSchool,Boston,
and Photonics, Department of ObGyn and MA,UnitedStates
Reproductive Biology, Beth Israel Deaconess Eric U. Yee Department of Pathology, Beth Israel
MedicalCenter,HarvardMedicalSchool,Boston, Deaconess Medical Center, Harvard Medical
MA,UnitedStates School,Boston,MA,UnitedStates
Nikhiel B. Rau Division of Gastroenterology, Beth Lei Zhang Center for Advanced Biomedical
Israel Deaconess Medical Center, Boston, MA, Imaging and Photonics, Department of ObGyn
UnitedStates and Reproductive Biology, Beth Israel Deaconess
Mandeep Sawhney Center for Advanced MedicalCenter,HarvardMedicalSchool,Boston,
Endoscopy, Department of Medicine, Beth Israel MA,UnitedStates
Deaconess Medical Center, Harvard Medical
School,Boston,MA,UnitedStates
AlisonSchneider DepartmentofGastroenterology,
Digestive Disease Center, Cleveland Clinic
Florida,Weston,FL,UnitedStates
Preface
In1999,IstartedtotreatBarrett’sesophagus This book brings the expertise of world
with photodynamictherapy. Iwas able to offer leaders in the field of Barrett’s Esophagus.
an endoscopic method to treat patients with Each author has provided a thorough review
high-grade dysplasia. The procedure was com- of their area of expertise. Within each chap-
plicated but it offered our nonsurgical patients ter, there has been a special emphasis on
an endoscopic method to treat high-grade dys- emerging evidence with a focus on where the
plasia. The patients were pleased that there future research and clinical practice will be
was a way to ablate the disease without sur- headed.
gery. Unfortunately photodynamic therapy was We would like to thank the authors for their
not an optimal therapy. Minor and major com- commitmenttoprovidingtheirtimeandexper-
plications were not infrequent. Buried Barrett’s tise. Each author is a recognized expert in their
was also a frequent occurrence. Since that time respective field. Special thanks to Dr. Helen
we have made major advances in our under- Shields of Harvard Medical School for provid-
standing of Barrett’s. Dr Erim and I identified a ing the photomicrograph on the front cover
need to provide a reference for those interested of this book. She is an outstanding resource for
inthetreatmentofpatientswiththisdisease. everythingrelatedtogastroenterology.Inaddi-
Our goal in bringing together this book was tion, we would like to thank the team at
to provide a framework for clinicians, clinical Elsevier for their skill in preparing this book.
researchers, and basic scientists. We hoped to Lastly, I would like to thank Tolga Erim for his
provide the practicing clinician, and the fellow leadership, dedication, and hard work to this
in-training with an in-depth text which pro- endeavor.
vides the basics and the state-of-the-art con-
cepts in one place. At the end of each chapter, DouglasK.Pleskow
our experts provide where they believe the Chief,ClinicalGastroenterology,
future research will be focused, providing BethIsraelDeaconessMedicalCenter,
invaluable insight into the minds of those who AssociateClinicalProfessorofMedicine,
willshapetheadvancesofthefuture. Boston,MA,UnitedStates
xiii
C H A P T E R
1
A Disease Entity Is Identified
1 2 3
Ya¸sar C¸olak , Tolga Erim and Douglas K. Pleskow
1DepartmentofGastroenterology,Go¨ztepeEducationandResearchHospital,IstanbulMedeniyet
University,Kadiko¨y,Istanbul,Turkey2DepartmentofGastroenterology,DigestiveDiseaseCenter,
ClevelandClinicFlorida,Weston,FL,UnitedStates3ClinicalGastroenterology,BethIsraelDeaconess
MedicalCenter,Boston,MA,UnitedStates
1.1 INTRODUCTION in this article and the history of the disease
datesbacktomucholdertimes[2].
Barrett’s esophagus (BE) is the presence of
metaplastic columnar epithelium in the lower
portion of the esophagus, which is normally 1.2 NORMAN RUPERT BARRETT
lined with stratified squamous epithelium. The (1903(cid:1)1979)
main cause of the disease is theorized to be
reflux esophagitis developed due to chronic Norman Rupert Barrett was born in North
acid exposure as a result of symptomatic or Adelaide, Australia, on May 16, 1903, the son
asymptomatic gastroesophageal reflux. In of Alfred Barrett and Catherine Hill Connor
addition, the disease is clinically significant as [3]. His paternal grandfather was a wealthy
a major risk factor for esophageal adenocarci- malt manufacturer who moved to Australia
noma(EAC). from England in the 1880s. When Barrett was
Barrett’s esophagus is named after Norman 10 years old, he moved from Australia to
Rupert Barrett, a highly regarded and success- London together with his parents and a youn-
ful thoracic surgeon of his period. Contrary to ger sister [4,5] where his brilliant academic
popularbelief,however,NormanBarrett’scon- career would start. Barrett would return to
tribution to the identification of the disease Australia after 50 years, as a visiting professor
wasquitelimited.Barrettwroteofthepresence atRoyalNorthShoreHospitalSydney,in1963.
of ulcers in the esophagus and the presence of BarrettreceivedhiseducationatEtonCollege
columnar epithelium around ulcers in an arti- (1917(cid:1)1922), then continued in Trinity College,
cle published in 1950 entitled “Chronic peptic and graduated from Cambridge University in
ulceroftheoesophagusand‘oesophagitis’”[1]. 1925. He completed his medical education at
However, there were number of inaccuracies St Thomas Hospital (1925(cid:1)1928). He continued
D.Pleskow&T.Erim(Eds):Barrett’sEsophagus.
DOI:http://dx.doi.org/10.1016/B978-0-12-802511-6.00001-6 1 ©2016ElsevierInc.Allrightsreserved.
2
1. ADISEASEENTITYISIDENTIFIED
asresidentassistantsurgeonforthenext2years him as the first editor of Thorax journal and he
at the same hospital and was elected to fellow- served as the editor of the journal until 1971.
ship of the Royal College of Surgeons in 1930 The first article by Barrett in the literature was
and the postgraduate degree M. Chir in 1931. a report of two cases and an associated litera-
He married Annabel Elizabeth “Betty” ture review that was titled “Surgical
Warington Smyth, his school friend, when he Emphysema During General Anesthesia” in
was28.ThenhebeganworkingatStThomasas 1944 [6]. He published an article about three
surgical staff, then as a consulting surgeon in cases with spontaneous esophageal perforation
1935 and spent his entire professional career and a literature review, his second article, in
there. Barrett’s first trip to America took place the first issue of Thorax in 1946 [7]. He also
when he became entitled to participate in the pioneered many advances in the field of tho-
Rockefeller Travelling Fellowship (1935(cid:1)1936) racic surgery. He successfully operated on a
program, a prestigious program at the Mayo case with esophageal rupture, which had been
Clinic. This program would also have a very previously considered fatal, and was the first
important place in Barrett’s career, since he to report it in the literature [8]. Barrett success-
would become interested in the emerging field fullyoperatedonacasewithesophagealdiver-
of thoracic surgery, and he would continue the ticulum using a thoracic approach, again the
restofhisprofessionallifeasathoracicsurgeon. first in the literature [9]. In addition, he wrote
There was still not a thoracic surgery depart- scientific articles on subjects such as removal
mentwhenhereturnedtoStThomas.Therefore, of pulmonary cysts [10(cid:1)12], surgical treatment
he continued to work as both a consulting gen- of bronchial carcinoma [13], primary tumors of
eral surgeon and a consulting thoracic surgeon the rib [14], achalasia [15], mediastinal fibrosis
atthesametime(Fig.1.1). [16], and congenital heart disease conditions
He became a member of the British Thoracic [17,18]. His other important contribution to the
Society, which was known as the Thoracic medical literature was the successful detection
Society atthat time.The ThoracicSociety chose of malignant cells in cytologicalexamination of
sputum with the “wet film” method in lung
cancerpatients[19].However,itwasthearticle
titled “Chronic peptic ulcer of the oesophagus
and ‘oesophagitis’” in 1950 that made the
name Norman Barrett famous in our day [1].
Barrett most likely could not estimate the great
influenceofhisarticleatthattime.
Barrett served as a president of the Thoracic
Society as well as president of the Thoracic
Surgeons of Great Britain and Ireland. He was
a member of the Court of Examiners of the
Royal College of Surgeons and he was an
examiner at universities of Oxford, Cambridge,
Birmingham, London, and Khartoum. He was
awardedtheCommanderoftheMostExcellent
Order of the British Empire in 1969 [3]. He
retired from St Thomas Hospital in 1970 after a
long and productive career and passed away
FIGURE1.1 NormanRupertBarrett. inLondononJanuary8,1979.
BARRETT’SESOPHAGUS
3
1.4HISTORYOFBARRETT’SESOPHAGUS
1.3 PHILIP ROWLAND ALLISON argued that Barrett had made a mistake in his
(1907(cid:1)1974) article in 1950. Allison identified peptic ulcer of
esophagus and used the expression “reflux
Whenwelookbackattheliteratureandsort esophagitis” first in the articles titled “Peptic
through the evidence of how intestinal meta- ulcer of the oesophagus” in 1946 [21] and 1948
plasia(IM)oftheesophaguswasidentified,we [22].Inaddition,hedescribedindetailandinan
find a particular scientist other than Norman accurate manner the function of the cardia, that
Barrett who played a key role. Dr Philip theesophagealepitheliumisnotresistanttogas-
Rowland Allison (1907(cid:1)1974) should arguably triccontents,andthatgastriccontentspassingto
be more prominent than Barrett in receiving theesophagusmaycauseesophagitisandulcer-
credit for the identification of the disease [20]. ation in cases in which the cardia function was
Allison was one of the leading cardiothoracic disabled due to reasons such as sliding hernia.
surgeons in England. He worked as a general Moreover, he mentioned radiological and histo-
surgeon and cardiothoracic surgeon for many logicalfindingsofthediseaseandidentifiedsur-
years in the Leeds General Infirmary. One of gical treatments in a detailed manner in these
his major achievements was the first successful articles.Allison,whowasmarriedandhadthree
cyanotic congenital heart disease surgery in children,diedinMarch6,1974.
1948 in Leeds. In addition to cardiovascular
surgery, he was a very successful surgeon in
1.4 HISTORY OF BARRETT’S
hernia surgery and published several scientific
ESOPHAGUS
articlesonthissubject(Fig.1.2).
Allison was the first person to use the
“columnary lined esophagus” phrase, correctly Contrarytopopularbelief,thehistoricaliden-
identifyingthehistologicalchange.Ironically,he tification of the disease process started much
was also the first person to use the expression earlier than in Barrett’s lifetime. Boehm
“Barrett’s ulcer” in the literature, when he describedgastroesophagealrefluxfirstinthelit-
erature in 1722 as follows: “acute pain which
reached down even to the stomach and which
wasaccompaniedbyhiccupandaconstantflow
of serum from the mouth” [23]. Joanne Petro
Frank [24] first used the expression “esophagi-
tis” in 1792. Johann Friedrich Hermann Albers,
a German physician and pathologist, was the
firsttoproposetheconceptofesophagealulcers
inhistoryin1839.Quinckereportedhistopatho-
logical findings of esophageal ulcers with the
presentation of three postmortem cases in 1879
[25,26].Thefirstscientificaccountofesophagitis
wasreportedbyMorellMackenzie,aBritishlar-
yngologist, in 1884 [27]. Mackenzie described
acute esophagitis in the Disease of the Gullet
section of his book as follows: “acute idiopathic
inflammation of the mucous membranes of the
esophagus, giving rise to extreme odynophagia,
FIGURE1.2 PhilipRowlandAllison. andoftentoaphagia.”
BARRETT’SESOPHAGUS