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EBO diagnostic -classification et surveillance M Benazzouz Rabat Session SMMAD/SMED Marrakech 2013

EBO diagnostic -classification et surveillance Diagnostic, classification et...protocole de Seattle •En as d’EBO out (< 3 m) ou en languettes : 2 à 4 biopsies tous les centimètres

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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

Comment ameacuteliorer le diagnostic endoscopiqueplace des biomarkeurs

Merci

Merci