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EBOdiagnostic -classification et
surveillance
M BenazzouzRabat
Session SMMADSMED
Marrakech 2013
objectifs
bull Repegraveres pour la jonction Oesogastrique
bull Classifications de Prague
bull protocole de Seattle
bull Modaliteacutes de surveillance
Introduction
bull DeacutefinitionLrsquoendobrachyoesophage (EBO) ou œsophage de Barrett correspond au remplacement de la muqueuse oesophagienne malpighiennenormale par une muqueuse glandulairebull Diagnostic
ndash aspect endoscopique eacutevocateurndash preacutesence drsquoun eacutepitheacutelium glandulaire sur
les biopsies œsophagiennes
3Types Histologiques
bull Type gastrique (fundus)
bull Type cardial +
bull Type intestinal +++++
Diagnostic endoscopique
Le diagnostic de lrsquoEBO doit ecirctre suspecteacute lorsque la ligne Z est situeacutee en amont de la JOG
Comment connaitre la jonction œsogastrique
ndash Extension proximale des plis gastriques
ndash Extension distale des vaisseaux palissadiques
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
objectifs
bull Repegraveres pour la jonction Oesogastrique
bull Classifications de Prague
bull protocole de Seattle
bull Modaliteacutes de surveillance
Introduction
bull DeacutefinitionLrsquoendobrachyoesophage (EBO) ou œsophage de Barrett correspond au remplacement de la muqueuse oesophagienne malpighiennenormale par une muqueuse glandulairebull Diagnostic
ndash aspect endoscopique eacutevocateurndash preacutesence drsquoun eacutepitheacutelium glandulaire sur
les biopsies œsophagiennes
3Types Histologiques
bull Type gastrique (fundus)
bull Type cardial +
bull Type intestinal +++++
Diagnostic endoscopique
Le diagnostic de lrsquoEBO doit ecirctre suspecteacute lorsque la ligne Z est situeacutee en amont de la JOG
Comment connaitre la jonction œsogastrique
ndash Extension proximale des plis gastriques
ndash Extension distale des vaisseaux palissadiques
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Introduction
bull DeacutefinitionLrsquoendobrachyoesophage (EBO) ou œsophage de Barrett correspond au remplacement de la muqueuse oesophagienne malpighiennenormale par une muqueuse glandulairebull Diagnostic
ndash aspect endoscopique eacutevocateurndash preacutesence drsquoun eacutepitheacutelium glandulaire sur
les biopsies œsophagiennes
3Types Histologiques
bull Type gastrique (fundus)
bull Type cardial +
bull Type intestinal +++++
Diagnostic endoscopique
Le diagnostic de lrsquoEBO doit ecirctre suspecteacute lorsque la ligne Z est situeacutee en amont de la JOG
Comment connaitre la jonction œsogastrique
ndash Extension proximale des plis gastriques
ndash Extension distale des vaisseaux palissadiques
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
3Types Histologiques
bull Type gastrique (fundus)
bull Type cardial +
bull Type intestinal +++++
Diagnostic endoscopique
Le diagnostic de lrsquoEBO doit ecirctre suspecteacute lorsque la ligne Z est situeacutee en amont de la JOG
Comment connaitre la jonction œsogastrique
ndash Extension proximale des plis gastriques
ndash Extension distale des vaisseaux palissadiques
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Diagnostic endoscopique
Le diagnostic de lrsquoEBO doit ecirctre suspecteacute lorsque la ligne Z est situeacutee en amont de la JOG
Comment connaitre la jonction œsogastrique
ndash Extension proximale des plis gastriques
ndash Extension distale des vaisseaux palissadiques
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Jonction œsogastrique
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Importance de lrsquoinssuflation
standard view of EGJ with airinflation excessive air deflation
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Importance de lrsquoinssuflation
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Influence des mouvements respiratoires sur la JOG
Expiration inspiration
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
In Japan howeverthe EGJ is defined endoscopically as the lower limit
of the palisade vessels
Kaiyo Takubo Digestion 2009N Ishimura Digestive Endoscopy 2009
in Japan when palisade vessels areseen through the metaplastic columnar epithelium a diagnosis
of CLE can be made by endoscopy alone
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Jonction oeso-gastrique
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Diagnostic endoscopique
bull Classification laquo CM raquo de Prague de LrsquoEBO
ndashC hauteur de lrsquoatteinte circonfeacuterentielle
ndashM hauteur maximale
bull deacuteduction ainsi de la hauteur des languettesbull Trois repegraveres anatomiques essentiels JOG ligne Z et
lrsquoempreinte correspondant agrave lrsquoorifice diaphragmatique
Isharma et al gastroenterology (2006)
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Classification de Prague
Sharma P et al Gastroenterology 20061311392-9
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
C4M6
Classification de Prague
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
3 types
bull Long gt 3 cm
bull Court lt 3 cm
bull Tregraves court lt 1 cm
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
86 endoscopistes ont classeacute 30 patients selon Prague
N Ishimura Digestive Endoscopy 2009
External study For C reliability coefficient of 094 Pour le M 094
for BE lt 1 cm the coefficient was only 022
Sharma P Gastroenterology2 006
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Le diagnostic de lrsquoEBO court est difficile en endoscopie34 experienced endoscopists
(minimum 5years experience in endoscopy and had performed at least 1000 endoscopic procedures)
YC LeeEndoscopy 2010
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
EBO court
C1M2
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Regravegles agrave respecter
bull Sous anestheacutesie agrave lrsquoaide drsquoun endoscope haute reacutesolution en lumiegravere blanche
bull Lrsquoexploration attentive
bull Toute anomalie muqueuse repeacutereacutee doit faire lrsquoobjet drsquoune localisation et drsquoune description preacutecise
bull Place de la chromo-endoscopie
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Classification de Parisdes leacutesions superficielles du tube digestif
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Classification de Parisdes leacutesions superficielles du tube digest
Cancer superficiel0-IIa
Metaplasie intestinale
T oyamaDigestive Endoscopy 2013
Cancer superficiel 0-Is
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Œsophage de Barrett la cartographie
endoscopique
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Biopsies sur EBOprotocole de Seattle
bull En cas drsquoEBO court (lt 3 cm) ou en languettes 2 agrave 4 biopsies tous les centimegravetres (1 pot par niveau)
bull En cas drsquoEBO long ( 3cm) 4 biopsies quadratiques tous les 2 cm(1 pot par niveau)
bull biopsies de toute anomalie de relief ou de coloration de la muqueuse oesophagienne
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Adherence to the Seattle biopsy protocol by length of BE
Adherence to guidelines was seen in 512 of cases
J A ABRAMSClin Gastroenterol Hepatol 2009
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Adherence to Biopsy Guidelines for Barrettrsquos EsophagusSurveillance in the Community Setting in the United States
Detection of dysplasia in cases adherent and nonadherent tothe Seattle protocol
J A ABRAMSClin Gastroenterol Hepatol 2009
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Classification de vienne
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Surveillance
bull Pourquoi agrave lrsquoeacutechelon individuel diagnostic preacutecoce de lrsquoadeacutenocarcinome
bull Pas drsquointeacuterecirct agrave lrsquoeacutechelon de la population geacuteneacuterale car bull Deacutefaut drsquoobservance du protocole de surveillance
bull Freacutequence eacuteleveacutee des EBO asymptomatiques
bull Quibull Les EBO longs et courts
bull Patients potentiellement curables
bull Age physiologique avanceacute que si les 1egraveres biopsies sont dysplasiques
SFED 2007
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
nationwide population-based cohort study11028 patients with Barrettrsquos esophagus and analyzed their data for a
median of 52 years
The annual risk of esophagealadenocarcinoma was 012 (95 CI 009 to 015)
Data from the current study call in toquestion the rationale for ongoing surveillance in patients who have Barrettrsquos esophagus
without dysplasia
Frederik Hvid-JensenNEJM october 13 2011
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Risk factors for cancer in Barrett esophagus annual risk of esophageal cancer is approximately 025 for patients without
dysplasia and 6 for patients with high-grade dysplasia
bull chronic GERD
bull hiatal hernia
bull advanced age
bull male sex
bull white race
bull cigarette smoking
bull obesity with an intra-abdominal body fat distribution
Spechler SJ JAMA 2013
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Quand depister ASGEAGAACP
bull Si RGO ancien avec
ndash Si symptocircmes freacutequents
ndash Symptocircmes nocturnes
ndash Agegt 50 ans
ndash Race blanche et sexe masculin
ndash Hernie hiatale
ndash IMC eacuteleveacute avec adipositeacute visceacuteral
ndash Tabac
N J ShaheenAnn Intern Med 2012
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Surveillance postion de lrsquo ASGE 2012
Gastrointest Endosc 2012
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Deacutepistage et surveillance de lrsquoEBOACG -PRACTICE GUIDELINES 2013
Philip O Katz Am J Gastroenterol 2013
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
EBO ASGE guides lines 2012
Gastrointest Endosc 2012
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Surveillanceles recommandations
bull SFED 2007
SFED 2007
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Overutilization of endoscopic surveillance in non dysplastic Barretts esophagus a multicenter study
bull The mean (plusmn SD) number of endoscopies per 3-year period was 27 plusmn 26
bull Oversurveillance was present in 65 of participants
bull A mean of 23 was excess endoscopies per patient observed
Crokett SD Gastrointest endosc 2012
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Comment ameacuteliorer le diagnostic endoscopique
bull Endoscope haute reacutesolution
bull Chromo-endoscopie
bull Autofluorescence
bull confocal laser endomicroscopy
bull Light scattering spectroscopy and diffuse reflectance spectroscopy
bull Optical coherence tomography
L Cassie J Gastrointest Oncol 2012
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
bull α-methylacyl-CoA racemase(AMCAR)
bull β-catenin
bull cyclin D1
bull p53
bull aneuploidy tetraploidy et de lrsquoheterozygositie(LOH) au niveau du chromosome 17p
L Cassie J Gastrointest Oncol 2012
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci
Romana IlligGastroenterology Research and Practice 2013
Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs
Merci