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Current State of Endoscopic Therapies in Barrett's Esophagus and Esophageal Cancer (DOI: 10.3810/hp.2011.02.388) (Postgraduate Medicine)

Barrett’s esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with nondysplastic BE, dysplastic BE, and early esophageal cancer have demonstrated their effectiveness in eradication of dysplasia with or without reversion of Barrett’s epithelium to normal squamous epithelium of the esophagus. These modalities are well tolerated, safe, and have few side effects. Ultimately, more research is needed regarding their ability to fully displace surgical intervention as the gold standard, although at this point their role in poor operative candidates or patients seeking conservative approaches remains promising.

Original Publication Date: February 2011

Barrett’s esophagus (BE) is a premalignant condition that predisposes patients to esophageal adenocarcinoma. This risk increases with increasing dysplasia, especially in patients with BE and high-grade dysplasia. Radical esophagectomy had long been the only option for these patients; however, it has been associated with significant morbidity and mortality. Endoscopic therapies have been increasingly used as an alternative to radical esophagectomy given the minimally invasive nature and tolerability of the procedure relative to surgery. Currently, the most widely used endoscopic therapies include endoscopic mucosal resection, photodynamic therapy, CryoSpray ablation, and radiofrequency ablation. Retrospective and prospective studies on the use of each of these modalities in patients with nondysplastic BE, dysplastic BE, and early esophageal cancer have demonstrated their effectiveness in eradication of dysplasia with or without reversion of Barrett’s epithelium to normal squamous epithelium of the esophagus. These modalities are well tolerated, safe, and have few side effects. Ultimately, more research is needed regarding their ability to fully displace surgical intervention as the gold standard, although at this point their role in poor operative candidates or patients seeking conservative approaches remains promising.

Original Publication Date: February 2011

Since my CCTV shot on Clifton Bridge was invited into the 1984 pool I have been amazed at actually how many of these things there are about. There was another one just yards from this one. I don't have any problem with them personally but their omnipresence is astonishing!

As I climed the wall to get into position the CCTV went round to look down the street, as it was panning back round to look at the other street it went straight past me and then came back for a double take lol it was amusing.

With its wide measurement range (Brix 0.0 to 53.0%) the PAL-1 works perfectly in measuring almost any fruit juice, food, or drink, such as soup, sauce, ketchup, tomato sauce, low-sugar jam, or marmalade. This refractometer is light & compact, only 100g. It is ergonomically designed for one-handed operation. The speedy performance of the PAL-1 is amazing. Simply put 2 to 3 drops of a sample on the prism surface and press the START key. The Brix value (sugar content / concentration) will be displayed in just 3 seconds. High temperature samples can be measured and the sample stage is designed to keep sample solutions from spilling out. It has a protection class of the PAL-1 is IP65. The sample can be rinsed off by running water on the sample stage. The design allows the user to easily wipe off the sample. The Automatic Temperature Compensation function of the PAL-1 enables you to take measurement readings regardless of the ambient temperature. High temperature samples can be measured and calibration is performed with water only. Measurement Range: Brix 0.0 to 53.0 %; Temperature 9.0 to 99.9°C. Measurement Accuracy: Brix ±0.2 %; Temperature ±1°C. Resolution: Brix 0.1 %; Temperature 0.1°C. Ambient Temperature: 10 to 40°C. Measurement Temperature: 10 to 100°C (Automatic Temperature Compensation). Sample Volume: 0.3ml. Measurement Time: 3 Seconds. International Protection Class: IP65 Dust-tight and Protected against Water Jets. Per each. Atago #: 3810.