Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials

Historic landscape character and sense of place

This is an Author's Accepted Manuscript of an article published in Landscape Research, 2013, Vol. 38, Issue 2 pp.179-202, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/01426397.2012.672642.Most studies of landscape character within archaeology and historical geography have focused on morphological features such as whether settlement patterns were nucleated or dispersed, but this paper discusses how adding depth to this, for example by studying place-names, vernacular architecture, and the territorial structures within which a landscape was managed in the past, gives us a far greater understanding of its texture and meaning to local communities. In two case-studies in southern Essex, for example, it is shown how the connections that once existed between inland and coastal communities can be used today to promote public access to the countryside. A further case study, in southwest England, shows how field-/place-names and vernacular architecture also make an important contribution to our appreciation of the time depth and complexity of landscape character.Arts and Humanities Research Council (AHRC)Southend-on-Sea Borough Counci

The development and survival of post-medieval vernacular houses A case study from Norfolk

In 2 vols.Available from British Library Document Supply Centre-DSC:DXN023410 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review.

Background and aim This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy. Methods This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. Main recommendations 1. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) 2.We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). 3.We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.) Conclusion Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems.</p

Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review.

Background and aim This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy. Methods This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. Main recommendations 1. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) 2.We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). 3.We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.) Conclusion Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems.</p

ACETIC ACID GUIDED BIOPSIES VERSUS MAPPING BIOPSIES FOR BARRETT'S SURVEILLANCE: THE ABBA STUDY

Aims: To compare neoplasia detection with AA targeted biopsies and protocol guided non-targeted biopsies during Barrett's surveillance. Methods: Multicentre randomized crossover feasibility study. Patients under surveillance for Barrett's metaplasia with no history of dysplasia/cancer were recruited. All patients underwent two gastroscopies 8 weeks apart, one with AA guided biopsy of abnormal areas only (Portsmouth Protocol) and one with non-targeted mapping biopsies (Seattle Protocol). Neoplasia yield and no. biopsies from each strategy was evaluated. Results: 200 patients recruited from 6 centres. Mean age 66yrs. Mean length C4M6. 175 patients completed both procedures. The prevalence of LGD, HGD and cancer was 11/192 (5.8%). All HGD and cancer was found with both protocols and confirmed with definitive treatment. One LGD was found with Portsmouth protocol and 5 LGD with Seattle protocol. This difference was not significant, and on follow up gastroscopy no neoplastic changes were found in any of the LGD cases. 2139 biopsies were taken using Seattle protocol at a cost of £125,987 (306 biopsies/neoplasia). 226 biopsies with Portsmouth Protocol at a cost of £13,311 (75 biopsies/neoplasia) a 4 fold difference. In terms of HGD/cancer, 1070 biopsies/neoplasia found using Seattle protocol and 113 biopsies/neoplasia using Portsmouth Protocol, a 9.5 fold difference. Conclusions: This is the first RCT comparing these techniques. No HGD or cancer was missed with either technique. There was a 4 fold reduction in biopsies per neoplasia detected with Portsmouth compared to Seattle protocol and a 9.5 fold difference when restricted to high risk neoplasia. If implemented nationally then this could lead to a massive reduction in histopathology work load and costs. LGD remains controversial and we believe inflammation could have resulted in false positive LGD as subsequent OGD and biopsies did not reveal any LGD. This feasibility data would support a definitive trial of AA targeted biopsies in a surveillance population