The Prevalence, Risk Factors and Optimal Biopsy Protocol of BE

NCT ID: NCT05818072

Last Updated: 2023-05-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

165 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-13

Study Completion Date

2026-12-31

Brief Summary

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Detections of goblet cells and dysplasia are crucial for diagnosis and determining the surveillance program of Barrett's esophagus (BE). However, the optimal biopsy numbers and their yield rates of intestinal metaplasia (IM) and dysplasia are still uncertain, especially in Asia. The aim of this study was to determine the optimal biopsy protocol of BE.

Detailed Description

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Barrett's esophagus (BE) is premalignant lesion for esophageal adenocarcinoma (EAC) and defined as the distal esophageal squamous epithelium replaced by columnar epithelium with histologic confirmation of intestinal metaplasia (IM). The accurate prevalence of BE is difficult to assess because part of people with BE are asymptomatic. However, the prevalence of gastroesophageal reflux disease (GERD) which is the main factor associated with BE has increased almost 50% during the last 20 years. Meanwhile, the general population prevalence of BE is estimated to increase to 3-10% in Western countries. The systematic review and meta-analysis also reported an upward trend in prevalence of BE in Asian countries. BE is an important heathy issue to investigate in either Western or Asian countries.

The annual rate of developing esophageal adenocarcinoma is around 0.2% to 0.5% in patients with BE. However, the annual adenocarcinoma progression risk is different between the non-dysplastic Barrett's esophagus (NDBE), BE with low-grade dysplasia (LGD) and high-grade dysplasia (HGD). The annual incidence of esophageal adenocarcinoma is 0.33%, 0.54% and 6.58% in patients with NDBE, BE with LGD and HGD, respectively. Among patients with NDBE, patients with short segment BE (SSBE) have the lower rate of progression to EAC than those who with long segment BE (LSBE) (0.07% vs 0.25%). Therefore, endoscopic surveillance of patients with BE is recommended by clinical practice guideline.

Detections of goblet cells and dysplasia are crucial for diagnosis and determining the surveillance program of BE. According to the Seattle protocol which has been widely recommended by clinical practice guidelines, biopsy specimens should be obtained every one cm to two cm interval across the four quadrants of the columnar epithelium of esophagus. Fewer endoscopists adhered to this protocol in clinical practice because of its laboriousness and time consumption. Most of patients with BE were categorized as SSBE and SSBE seems to be more prevalent in Asian populations. As the report of previous study which reviewed the general prevalence of BE in Western and Asian general populations, the ratio of SSBE to LSBE was ranging from 1.8 to 17.4 in the Western countries and 1.7 to 103 in the Asian countries. It's more difficult to adhere to the protocol in patients with SSBE.

However, the optimal biopsy numbers and their yield rates of IM and dysplasia are still uncertain, especially in Asia. The investigators aimed to assess the biopsy numbers and yield rates of IM and dysplasia in patients with columnar-lined esophagus (CLE) to determine the optimal biopsy protocol.

Conditions

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Barrett's Esophagus Intestinal Metaplasia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Participants

Study Groups

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One biopsy

Obtain one biopsy specimen at the proximal part of the the longest columnar-lined esophagus for patients with suspected Barrett's Esophagus

Group Type EXPERIMENTAL

One biopsy

Intervention Type PROCEDURE

To do one biopsy at the proximal part of the longest columnar-lined esophagus.

Endoscopy

Intervention Type DEVICE

The participants will receive meticulous endoscopic examination with narrow-band imaging.

Three biopsy

Obtain three biopsy specimens at the proximal, middle and distal part of the longest columnar-lined esophagus for patients with suspected Barrett's Esophagus

Group Type ACTIVE_COMPARATOR

Three biopsy

Intervention Type PROCEDURE

To do three biopsy at the proximal, middle and distal part of the longest columnar-lined esophagus.

Endoscopy

Intervention Type DEVICE

The participants will receive meticulous endoscopic examination with narrow-band imaging.

Seattle protocol

Obtain 4-quadrant biopsy specimens at intervals of every 1 to 2 cm throughout the the columnar-lined esophagus for patients with suspected Barrett's Esophagus

Group Type SHAM_COMPARATOR

Seattle protocol

Intervention Type PROCEDURE

To do 4-quadrant biopsy every 1-2 cm at the esophagogastric junction. Seattle protocol has been considered as the gold standard biopsy protocol for patients with suspected Barrett's Esophagus.

Endoscopy

Intervention Type DEVICE

The participants will receive meticulous endoscopic examination with narrow-band imaging.

Interventions

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One biopsy

To do one biopsy at the proximal part of the longest columnar-lined esophagus.

Intervention Type PROCEDURE

Three biopsy

To do three biopsy at the proximal, middle and distal part of the longest columnar-lined esophagus.

Intervention Type PROCEDURE

Seattle protocol

To do 4-quadrant biopsy every 1-2 cm at the esophagogastric junction. Seattle protocol has been considered as the gold standard biopsy protocol for patients with suspected Barrett's Esophagus.

Intervention Type PROCEDURE

Endoscopy

The participants will receive meticulous endoscopic examination with narrow-band imaging.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adults with columnar-lined esophagus

Exclusion Criteria

* A prior history of endoscopic treatment for Barrett's Esophagus
* A prior history of upper gastrointestinal malignancy
* A prior history of total or subtotal gastrectomy
* Esophageal varices noted during the procedure
* Uncontrolled coagulopathy
* Taking antiplatelet drug or anticoagulant
Minimum Eligible Age

20 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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E-DA Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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E-DA Hospital

Kaohsiung City, , Taiwan

Site Status RECRUITING

Countries

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Taiwan

Central Contacts

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Ying-Nan Tsai, M.D

Role: CONTACT

886-7-6150011 ext. 252294

Wen-Lun Wang, Ph.D

Role: CONTACT

886-7-6150011 ext. 251346

Facility Contacts

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Ying Nan Tsai, M.D

Role: primary

886-7-6150011 ext. 252294

References

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Sharma P. Barrett Esophagus: A Review. JAMA. 2022 Aug 16;328(7):663-671. doi: 10.1001/jama.2022.13298.

Reference Type RESULT
PMID: 35972481 (View on PubMed)

Richter JE, Rubenstein JH. Presentation and Epidemiology of Gastroesophageal Reflux Disease. Gastroenterology. 2018 Jan;154(2):267-276. doi: 10.1053/j.gastro.2017.07.045. Epub 2017 Aug 3.

Reference Type RESULT
PMID: 28780072 (View on PubMed)

Shiota S, Singh S, Anshasi A, El-Serag HB. Prevalence of Barrett's Esophagus in Asian Countries: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2015 Nov;13(11):1907-18. doi: 10.1016/j.cgh.2015.07.050. Epub 2015 Aug 7.

Reference Type RESULT
PMID: 26260107 (View on PubMed)

Desai TK, Krishnan K, Samala N, Singh J, Cluley J, Perla S, Howden CW. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut. 2012 Jul;61(7):970-6. doi: 10.1136/gutjnl-2011-300730. Epub 2011 Oct 13.

Reference Type RESULT
PMID: 21997553 (View on PubMed)

Singh S, Manickam P, Amin AV, Samala N, Schouten LJ, Iyer PG, Desai TK. Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2014 Jun;79(6):897-909.e4; quiz 983.e1, 983.e3. doi: 10.1016/j.gie.2014.01.009. Epub 2014 Feb 17.

Reference Type RESULT
PMID: 24556051 (View on PubMed)

Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P. Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008 Mar;67(3):394-8. doi: 10.1016/j.gie.2007.07.019. Epub 2007 Nov 28.

Reference Type RESULT
PMID: 18045592 (View on PubMed)

Hamade N, Vennelaganti S, Parasa S, Vennalaganti P, Gaddam S, Spaander MCW, van Olphen SH, Thota PN, Kennedy KF, Bruno MJ, Vargo JJ, Mathur S, Cash BD, Sampliner R, Gupta N, Falk GW, Bansal A, Young PE, Lieberman DA, Sharma P. Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma. Clin Gastroenterol Hepatol. 2019 Apr;17(5):864-868. doi: 10.1016/j.cgh.2018.07.008. Epub 2018 Aug 8.

Reference Type RESULT
PMID: 30012433 (View on PubMed)

Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, Wani S. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-587. doi: 10.14309/ajg.0000000000001680.

Reference Type RESULT
PMID: 35354777 (View on PubMed)

Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O'Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J; British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014 Jan;63(1):7-42. doi: 10.1136/gutjnl-2013-305372. Epub 2013 Oct 28.

Reference Type RESULT
PMID: 24165758 (View on PubMed)

Abrams JA, Kapel RC, Lindberg GM, Saboorian MH, Genta RM, Neugut AI, Lightdale CJ. Adherence to biopsy guidelines for Barrett's esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol. 2009 Jul;7(7):736-42; quiz 710. doi: 10.1016/j.cgh.2008.12.027. Epub 2009 Jan 13.

Reference Type RESULT
PMID: 19268726 (View on PubMed)

Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, Vieth M, Stolte M, Talley NJ, Agreus L. Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology. 2005 Dec;129(6):1825-31. doi: 10.1053/j.gastro.2005.08.053.

Reference Type RESULT
PMID: 16344051 (View on PubMed)

Tseng PH, Lee YC, Chiu HM, Huang SP, Liao WC, Chen CC, Wang HP, Wu MS, Lin JT. Prevalence and clinical characteristics of Barrett's esophagus in a Chinese general population. J Clin Gastroenterol. 2008 Nov-Dec;42(10):1074-9. doi: 10.1097/MCG.0b013e31809e7126.

Reference Type RESULT
PMID: 18360296 (View on PubMed)

Other Identifiers

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EDAHS-111031

Identifier Type: -

Identifier Source: org_study_id

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