ABSTRACT
Barret's esophagus (BE) is defined as a situation in which the distal esophageal squamous epithelium was replaced by columnar epithelium, with or without goblet cells. BE is considered a significant risk factor for the development of esophageal cancer, however, screening is recommended only for high risk patients. The new guidelines determine the proper terminology of the endoscopic appearance of BE and the way that biopsies should be taken. After BE is confirmed, surveillance is extremely important as its performance has been shown to prevent cancer and death. The surveillance is based on the endoscopic and pathological findings, highlighting the importance of advanced endoscopy and specialized pathology expertise. The guidelines determine the place of the endoscopic ablative technology and specialized surgery in these patients.
Subject(s)
Barrett Esophagus/diagnosis , Esophagoscopy/methods , Practice Guidelines as Topic , Barrett Esophagus/complications , Barrett Esophagus/pathology , Biopsy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/etiology , Esophageal Neoplasms/prevention & control , Humans , Mass Screening/methods , Risk Factors , Terminology as TopicABSTRACT
The position paper recommends specific guidelines for surveillance of patients with atrophic gastritis, gastric intestinal metaplasia and dysplasia. Although gastric atrophy and intestinal metaplasia are recognized as premalignant conditions, there is insufficient data to recommend routine endoscopic surveillance. However, when endoscopy is performed, it should include topographic mapping for biopsies of the entire stomach, particularly the lesser curvature. Patients with confirmed high grade dysplasia should be considered for gastrectomy or local endoscopic resection because of high probability for development of adenocarcinoma.
Subject(s)
Gastritis, Atrophic/diagnosis , Gastrointestinal Diseases/diagnosis , Practice Guidelines as Topic , Adenocarcinoma/prevention & control , Endoscopy, Gastrointestinal/methods , Gastrectomy/methods , Gastritis, Atrophic/complications , Gastritis, Atrophic/pathology , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/pathology , Humans , Metaplasia/diagnosis , Precancerous Conditions/diagnosis , Precancerous Conditions/pathologyABSTRACT
The position paper of the GastrointestinaL Oncology Section of the Israeli Gastroenterological Association recommends specific guidelines for surveillance after polypectomy and curative resection of colorectal cancer. Periodic colonoscopy is necessary for early detection of metachronous lesions or cancer recurrence. After polypectomy of a simple hyperplasic polyp, colonoscopy is repeated in 10 years. Small adenoma dictates colonoscopy after 5-10 years. In the case of advanced adenoma, repeat coLonoscopy is to be conducted after 3 years. The personal impression of the colonoscopists may advance procedures to an earlier colonoscopy, especially after piecemeal polypectomy of a large sessile polyp. Fecal occult blood test or any other screening procedures are not needed after polypectomy. Colonoscopy, carcinoembrionic antigen examination (CEA) and liver imaging are necessary for surveillance after curative resection of colorectal cancer, and improve survival. Total colonoscopy should be performed before the operation or in cases with obstructive carcinoma, colonic imaging should be completed with virtual colonoscopy. Total colonoscopy should be performed 3-6 months after surgery if not conducted previously. The next follow-up is needed 3 and 5 years after the operation. After low anterior resection, the recurrence rate may be high and patients who have not undergone radiation therapy nor mesorectal resection should undergo sigmoidoscopy every 3-6 months for 2-3 years after surgery.
