CC Nov 2015 Barrett's Esophagus

echoecho's version from 2015-12-16 14:25


Question Answer
Define Barrett's Esophagus (BE)?replacement of normal squamous epithelium in the lower esophagus with mucus-secreting columnar epithelium (intestinalization)
The diagnostic criteria of the American Society of Gastroenterology requires the presence of _____ _____ on biopsy, while the British Society of Gastroenterology criteria do not?goblet cells
What is the the endoscopic appearance of BE? What is the endoscopic appearance of normal esophageal squamous epithelium?1) salmon-colored and coarse 2) pale, smooth
This nondysplastic (metaplastic) intestinalization of the lower esophagus has ______ potential?premalignant
BE occurs as a result of chronic tissue injury from what 2 conditions?1) acid reflux 2) bile reflus
BE is further subcategorized into _____ or ______ segment, with _____ or ______ histology?1) short (<3 cm); long 2) dysplastic ; nondysplastic
BE is a precursor lesion to what cancer? BE is NOT a precursor lesion to what cancer?1) esophageal adenocarcinoma (EAC) 2) squamous cell carcinoma
There is an _____-fold increase in risk of adenocarcinoma in patients with BE compared to the general population?11
Recent studies have called into question the value of an _______ surveillance strategy for many patient with BE?endoscopic
Whys is identifying target population for screeing is problematic?while GERD is associated with BE, about 40% of cases of EAC occur in patients WITHOUT hx of GERD
*** The American Gastroenterological Association (AGA) recommends ______ (for vs against) screening all patients with GERD?against
***True or false? A two-time screening is suggested in patients with multiple risk fxs for adenocarcinoma?false; a one-time screening is suggested
*** List 7 risk factors for adenocarcinoma?1) > 50 years 2) male gender 3) white race 4) hiatal hernia 5) intraabdominal fat distribution 6) obesity 7) smoking
*** If BE is not identified, what is the treatment plan?no further screening is warranted
*** If BE WITHOUT dysplasia is identified, what is the treatment plan?further surveillance should be no more frequent than every 3 to 5 years
*** Shorter surveillance intervals are indicated if what is identified?dysplasia
*** Select patients with dysplasia may be candidates for what procedure?endoscopic radiofrequency ablation
What is the premise of surveillance of BE?reduces the risk of death from cancer
The above premise has been questioned, and what evidence is present related to this?that BE is overdiagnosed
In an observational study, a previous dx of BE was not confirmed in ____ of 130 patients evaluated by a team of expert endoscopists?42
A previous dx of _____ (short vs. long) was more likely to be revised than a dx of _____ (short vs. long) segment disease?)short; long
True or false? Recent studies suggest that the absolute risk of cancer in patients with BE is lower than previously thought?true
A Danish study of > 11,000 patients with BE found that the overall risk of esophageal adenocarcinoma (EAC) was _____ cases per 1,000 patient years?1.2
In patients with NO dysplasia at baseline, the risk was _____ cases per 1000 patients?1.0
In patients with low-grade dysplasia the risk was _____ cases per 1000 patients?5.1
In a case-control study in California, what was the finding regarding the benefit of surveillance?though this study lacked the power to r/o a small benefit of surveillance, the authors noted that any benefit would be substantially smaller than previous estimates used in developing the surveillance guidelines
What strength is the evidence to support screening for BE or surveillance of nondysplastic BE?weak
List 2 newer diagnostic and screening tools that require no anesthesia or prolonged recovery and may reduce the risk of screening and improve acceptance by the patients?1) Ultrathin endoscope 2) trans-nasal endoscope
What other advances are on the horizon associated with EAC which may improve the reliability of screening and change the current screening recommendations?biomarkers that identify chromosomal abnormalities or other genetic markers
*** SUMMARY = Barrett's esophagus is a precursor lesion to _____ ______ but NOT squamous cell carcinoma?esophageal adenocarcinoma
*** SUMMARY = What is the recommendation for routine screening of all patients with GERD for BE?not recommended
*** SUMMARY = Current AGA (American Gastroenterological Association) guidelines suggest that patients with BE WITHOUT dysplasia should NOT have endoscopy more frequently than every ____ to _____ years and recent studies call into questions whether any further surveillance is necessary?3; 5