• Laparoscopic Roux-en-Y gastric bypass
• Laparoscopic sleeve gastrectomy
• Laparoscopic sleeve gastrectomy + jejunojejunal bypass
• Metabolic syndrome
• Obesity
• Type 2 diabetes mellitus

• Humans
• Metabolic Syndrome/surgery
• Retrospective Studies
• Female
• Male
• Adult
• Obesity, Morbid/surgery
• Obesity, Morbid/complications
• Gastric Bypass/methods
• Treatment Outcome
• Laparoscopy/methods
• Weight Loss
• Gastrectomy/methods
• Middle Aged
• Insulin Resistance
• Body Mass Index

• 2022B1111020006 Key Technologies Research and Development Program of Guangzhou Municipality
• 202002020069 Science and Technology Planning Project of Guangdong Province

• Esophagitis
• Gastroesophageal reflux
• Metabolic syndrome
• Obesity
• Remission

• bacteriology
• gastrointestinal neoplasms
• infectious disease medicine
• medical oncology
• public health

• GBD
• average annual percentage change
• cancer
• epidemiology
• esophageal cancer
• gastric cancer
• global burden of disease
• incidence
• spatiotemporal analysis
• spatiotemporal correlation

• Humans
• Stomach Neoplasms/epidemiology
• Incidence
• Esophageal Neoplasms/epidemiology
• Spatio-Temporal Analysis
• Female
• Male
• Risk Factors
• Global Burden of Disease

• Gastroesophageal reflux disease
• Markov model
• RefluxStop
• cost-effectiveness
• cost-utility
• fundoplication
• laparoscopic antireflux surgery
• proton pump inhibitors

• Mendelian randomization
• SNPs
• blood metabolites
• colocalization analysis
• esophageal cancer

• National Natural Science Foundation of China

• Humans
• Esophagitis/drug therapy
• Esophagitis, Peptic/drug therapy
• Gastroesophageal Reflux/drug therapy
• Network Meta-Analysis
• Proton Pump Inhibitors/therapeutic use
• Pyrroles
• Randomized Controlled Trials as Topic
• Sulfonamides
• Treatment Outcome

• 2023A1515010187 Natural Science Foundation of Guangdong Province
• 2022A1515111159 Provincial and municipal joint fund youth project of guangdong
• 81970479 National Natural Science Foundation of China

• Access to care
• GERD (gastroesophageal reflux disease)
• Gastric bypass
• Insurance
• Payers
• Reflux

• Humans
• Gastric Bypass/methods
• Gastroesophageal Reflux/surgery
• Gastroesophageal Reflux/complications
• Obesity, Morbid/surgery
• Obesity, Morbid/complications
• Retrospective Studies
• Surgeons
• Insurance
• Treatment Outcome

• Humans
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/genetics
• Risk Factors
• Sleep
• Genetic Predisposition to Disease
• Disorders of Excessive Somnolence
• Adenocarcinoma

• P30 CA091842 NCI NIH HHS

• Animals
• Swine
• Esophageal Sphincter, Lower
• Gastrointestinal Tract
• Stents
• Pressure
• Electric Stimulation

• Innovation and Technology Commission
• Croucher Foundation Grant
• Hong Kong RGC Research Fellow Scheme

• Barrett’s esophagus
• adenocarcinoma
• fundoplication
• gastroesophageal reflux
• proton pump inhibitors

We evaluated the microbiota in the stomach of Gastroesophageal Reflux Disease (GERD) patients. We compared Erosive Reflux Disease (ERD) to gastritis and Non-erosive Reflux Disease (NERD) subjects by 16S rRNA approach on gastric biopsy specimens. A total of 197 subjects were included consisting of gastritis (68; 34.52%), ERD (55; 27.92%), and NERD (74; 37.56%). After quality filtering, 187 samples were included for OTU analysis using Qiime2.

We observed a significant difference in alpha diversity (Shannon and Simpson indexes were P = 0.0016 and P = 0.017, respectively). A significant decrease in alpha diversity index was observed in NERD with Helicobacter pylori (H. pylori)-positive subjects than in gastritis (Simpson index P = 0.022; Shannon index P = 0.029), indicating a significant influence of H. pylori on the diversity in the stomach despite the diseases. In H. pylori-negative samples, alpha diversity measurement by the abundance coverage estimates (ACE) and Fisher Test revealed that ERD had significantly lower richness than gastritis and NERD groups (P = 0.00012 and P = 0.00043, respectively). Anaerobacillus sp. could only be found in ERD patients by LEFse analysis.

The presence of ERD could alter microbiome diversity. A negative correlation between H. pylori and ERD is shown in this microbiome study but not in NERD.

The online version contains supplementary material available at 10.1186/s13099-022-00510-3.

Barrett’s esophagus (BE) is the only known precursor lesion of esophageal adenocarcinoma (EAC). Endoscopic surveillance plays an important role in the timely detection of neoplastic progression. However, the cost-effectiveness of current surveillance strategies is debatable. Previous studies have shown that male Barrett’s patients have lower neoplastic progression risk than females. However, these studies do not provide a more practical translation of these sex disparities into different surveillance intervals. The current multicenter prospective cohort study aimed to evaluate sex differences in 868 BE patients; not only with respect to neoplastic progression risk, but also concerning the difference in time to detection of high-grade dysplasia (HGD)/EAC: time to neoplastic progression was estimated to be almost twice as low in males than in females. In contrast, the stage of neoplasia appeared to be higher in females. Our results can guide future discussions for sex-specific guidelines, supporting the implementation of neoplastic risk stratification per individual patient in BE surveillance.

Recommendations in Barrett’s esophagus (BE) guidelines are mainly based on male patients. We aimed to evaluate sex differences in BE patients in (1) probability of and (2) time to neoplastic progression, and (3) differences in the stage distribution of neoplasia. We conducted a multicenter prospective cohort study including 868 BE patients. Cox regression modeling and accelerated failure time modeling were used to estimate the sex differences. Neoplastic progression was defined as high-grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). Among the 639 (74%) males and 229 females that were included (median follow-up 7.1 years), 61 (7.0%) developed HGD/EAC. Neoplastic progression risk was estimated to be twice as high among males (HR 2.26, 95% CI 1.11–4.62) than females. The risk of HGD was found to be higher in males (HR 3.76, 95% CI 1.33–10.6). Time to HGD/EAC (AR 0.52, 95% CI 0.29–0.95) and HGD (AR 0.40, 95% CI 0.19–0.86) was shorter in males. Females had proportionally more EAC than HGD and tended to have higher stages of neoplasia at diagnosis. In conclusion, both the risk of and time to neoplastic progression were higher in males. However, females were proportionally more often diagnosed with (advanced) EAC. We should strive for improved neoplastic risk stratification per individual BE patient, incorporating sex disparities into new prediction models.

• Age and HSA
• Esophageal hiatus
• Hiatal surface area
• MDCT images
• Sex and HSA

Barrett's esophagus (BE) is an endoscopically identifiable premalignant condition for esophageal adenocarcinoma (EAC). To diagnose BE precisely, careful inspection of the anatomic landmarks, including the esophagogastric junction and the squamocolumnar junction is important. The distal end of the palisade vessels and the proximal end of the gastric folds are used as the landmark of the esophagogastric junction in endoscopic diagnosis, with the latter solely used internationally, except in some Asian countries, including Japan. In addition, the diagnostic criteria adopted internationally for BE are inconsistent, particularly between Japan and Western countries. Recently updated guidelines in Western countries have included length criteria, with a 1‐cm threshold of columnar epithelium by endoscopic observation and/or histologic confirmation of the presence of specialized intestinal metaplasia. Since BE is endoscopically diagnosed at any length without histologic assessment in Japan, the reported prevalence of short‐segment BE is very high in Japan compared with that in Western countries. Although guidelines on screening exist for BE, the current strategies based on the presence of chronic gastroesophageal reflux disease with multiple risk factors may miss the opportunity for early detection of EAC. Indeed, up to 40% of patients with EAC have no history of chronic gastroesophageal reflux disease. To discuss BE on the same footing worldwide, standardization of diagnostic criteria, screening indication, and establishment of effective techniques for detecting dysplastic lesions are eagerly awaited. Japanese guidelines for BE should be revised regarding the length criteria, including the minimum length and long‐segment BE, in line with the recently updated Western guidelines.

• Colorectal cancer
• Gastroesophageal reflux disease
• National Health Insurance Research Database
• Retrospective cohort study

Laryngopharyngeal reflux, a variant of gastroesophageal reflux disease, has been considered a risk factor in the development of hypopharyngeal cancer. Bile acids are frequently present in the gastroesophageal refluxate and their effect has been associated with inflammatory and neoplastic changes in the upper aerodigestive tract. Recent in vitro and in vivo studies have provided direct evidence of the role of acidic bile refluxate in hypopharyngeal carcinogenesis and documented the crucial role of NF-κB as a key mediator of early oncogenic molecular events in this process and also suggested a contribution of STAT3. Acidic bile can cause premalignant changes and invasive squamous cell cancer in the affected hypopharynx accompanied by DNA damage, elevated p53 expression and oncogenic mRNA and microRNA alterations, previously linked to head and neck cancer. Weakly acidic bile can also increase the risk for hypopharyngeal carcinogenesis by inducing DNA damage, exerting anti-apoptotic effects and causing precancerous lesions. The most important findings that strongly support bile reflux as an independent risk factor for hypopharyngeal cancer are presented in the current review and the underlying mechanisms are provided.

• DNA damage
• NF‑κB
• bile reflux
• conjugated bile acids
• deoxycholic acid
• head and neck cancer
• hypopharyngeal cancer; hypopharyngeal squamous cell carcinoma
• in vivo
• laryngopharyngeal reflux

The genetic characteristics of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in the Japanese population is unclear. This study aims to investigate the genetic characteristics from nondysplastic BE (NDBE) to early EAC in Japan. Clinical information was collected. Moreover, the genetic profile of NDBE without concurrent dysplasia, early EAC, and surrounding BE were also investigated using endoscopic biopsy samples and formalin-fixed, paraffin-embedded specimens from Japanese patients by targeted next-generation sequencing. Immunohistochemical staining for p53 was also performed for EAC lesions. Targeted NGS was performed for 33 cases with 77 specimens. No significant difference exists in the NDBE group between the number of putative drivers per lesion in the short-segment Barrett’s esophagus (SSBE) and long-segment Barrett’s esophagus (LSBE) [0 (range, 0–1) vs. 0 (range, 0–1). p = 1.00]. TP53 putative drivers were found in two patients (16.7%) with nondysplastic SSBE. TP53 was the majority of putative drivers in both BE adjacent to EAC and EAC, accounting for 66.7% and 66.7%, respectively. More putative drivers per lesion were found in the EAC than in the NDBE group [1 (range, 0–3) vs. 0 (range, 0–1). p < 0.01]. The genetic variants of TP53 in the Japanese early EAC were similar to those in western countries. However, TP53 putative drivers were detected even in Japanese patients with nondysplastic SSBE. This is significant because such nondysplastic SSBE might have higher risk of progressing to high-grade dysplasia or EAC. The risks of progression may not be underestimated and appropriate follow-ups may be necessary even in patients with SSBE.

Trial registration: This study was registered at the University Hospital Medical Information Network (UMIN000034247).

Cancer of the esophagus is a deadly disease. There are two main subtypes, adenocarcinoma and squamous cell carcinoma, with adenocarcinoma of the esophagus (EAC) being more common in Western countries. Barrett’s esophagus (BE) describes a change in the esophageal surface near the stomach in response to reflux of gastric acid into the esophagus. BE increases the risk of developing EAC, and the incidence of EAC has risen dramatically over recent decades. One likely reason for the poor prognosis of EAC is based on the fact that each tumor has many genes affected by mutations, and most of these genes differ across patients, hampering the efficacy of therapies that target specific cancer driver proteins. In this review, we provide an overview of the gene mutations and gene activity changes in EAC and how these features can be used to divide patients into groups that might have different clinical characteristics.

Esophageal adenocarcinoma (EAC) is a deadly disease with limited options for targeted therapy. With the help of next-generation sequencing studies over the last decade, we gained an understanding of the genomic architecture of EAC. The tumor suppressor gene TP53 is mutated in 70 to 80% of tumors followed by genomic alterations in CDKN2A, KRAS, ERBB2, ARID1A, SMAD4 and a long tail of less frequently mutated genes. EAC is characterized by a high burden of point mutations and genomic rearrangements, resulting in amplifications and deletions of genomic regions. The genomic complexity is likely hampering the efficacy of targeted therapies. Barrett’s esophagus (BE), a metaplastic response of the esophagus to gastro-esophageal reflux disease, is the main risk factor for the development of EAC. Almost all EACs are derived from BE. The sequence from BE to EAC provides an opportunity to study the genomic evolution towards EAC. While the overlap of point mutations between BE and EAC within the same patient is, at times, surprisingly low, there is a correlation between the complexity of the genomic copy number profile and the development of EAC. Transcriptomic analyses separated EAC into a basal and a classical subtype, with the basal subtype showing a higher level of resistance to chemotherapy. In this review, we provide an overview of the current knowledge of the genomic and transcriptomic characteristics of EAC and their relevance for the development of the disease and patient care.

• Barrett’s esophagus
• esophageal adenocarcinoma
• genomics
• mutation
• transcriptomics
• tumor development

• Adolescent
• Bariatric
• Obesity
• Pediatric
• Surgery

Obesity is a global epidemic posing a significant burden on patients and healthcare systems. Gastroesophageal reflux disease is associated with obesity and its prevalence is also growing worldwide. Numerous bariatric surgeries and endoscopic procedures have arisen to assist with weight loss and management of obesity-related conditions. However, the effect of these interventions on reflux is variable and the evidence is often conflicting. To date, Roux-en-Y gastric bypass remains the gold-standard for attaining both reflux and weight loss management, however novel endoscopic techniques are quickly becoming more prevalent as an alternative to surgery. This review aims to summarize currently available endoscopic and surgical weight loss procedures and their impact on reflux symptoms while emphasizing areas requiring additional investigation.

• Bariatrics
• Gastrectomy
• Gastroesophageal reflux
• Obesity

• Barrett's esophagus
• Dysplasia
• Esophageal adenocarcinoma
• Intestinal metaplasia
• Surveillance

• Barrett’s esophagus
• Esophageal adenocarcinoma
• Gastroesophageal reflux disease
• Screening
• Surveillance

Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41–3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29–3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52–4.18) than those without pesticide/detergent intoxication. Conclusion: In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.

• Adult
• Aged
• Carcinoma/chemically induced
• Carcinoma/epidemiology
• Carcinoma/pathology
• Caustics/poisoning
• Cohort Studies
• Detergents/poisoning
• Eating/drug effects
• Esophageal Neoplasms/chemically induced
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/pathology
• Female
• Humans
• Male
• Middle Aged
• Pesticides/poisoning
• Proportional Hazards Models
• Risk Factors

• Barrett's carcinoma
• Barrett's oesophagus
• oesophageal cancer
• pre-malignancy - gi tract
• screening

• K24 DK080941 NIDDK NIH HHS
• U01 CA152926 NCI NIH HHS
• U54 CA163059 NCI NIH HHS
• P50 CA150964 NCI NIH HHS
• U54 CA163060 NCI NIH HHS
• MR/S003851/1 Medical Research Council
• U01 CA199336 NCI NIH HHS
• National Cancer Institute
• National Institute of Diabetes and Digestive and Kidney Diseases

• Immunotherapy
• checkpoint inhibitor
• gastric cancer
• gastroesophageal
• malignancy

The present study aimed to evaluate the efficacy of linked color imaging (LCI) in diagnosing Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC).

A total of 112 and 12 consecutive patients with BE and EAC were analyzed. The visibility scores of BE and EAC ranging from 4 (excellent visibility) to 0 (not detectable) were evaluated by three trainees and three experts using white light imaging (WLI), LCI mode, and blue laser imaging bright (BLI-b) mode. In addition, L∗a∗b∗ color values and color differences (ΔE∗) were evaluated using the CIELAB color space system.

The visibility score of the BE in LCI mode (2.94 ± 1.32) was significantly higher than those in WLI (2.46 ± 1.48) and BLI-b mode (2.35 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent gastric mucosa in LCI mode (17.11 ± 8.53) was significantly higher than those in other modes (12.52 ± 9.37 in WLI and 11.96 ± 6.59 in BLI-b mode, p < 0.01). The visibility scores of EAC in LCI mode (2.56 ± 1.47) and BLI-b mode (2.51 ± 1.28) were significantly higher than that in WLI (1.64 ± 1.46) (p < 0.01). The color difference (ΔE∗) from the adjacent normal Barrett's mucosa in LCI mode (19.96 ± 7.97) was significantly higher than that in WLI (12.95 ± 11.86) (p = 0.03).

The present findings suggest that LCI increases the visibility of BE and EAC and contributes to the improvement of the detection of these lesions.

• Complications
• Dysphagia
• Gastroesophageal reflux disease
• Laparoscopic fundoplication
• Nissen fundoplication
• Trend

• Dental erosion
• Gastroesophageal reflux extraesophageal disease
• Halitosis
• Nocturnal cough

• Adolescent
• Asthma/epidemiology
• Asthma/etiology
• Cough/epidemiology
• Cough/etiology
• Cross-Sectional Studies
• Deglutition Disorders/epidemiology
• Deglutition Disorders/etiology
• Female
• Gastroesophageal Reflux/complications
• Gastroesophageal Reflux/epidemiology
• Halitosis/epidemiology
• Halitosis/etiology
• Humans
• Male
• Nigeria/epidemiology
• Pharyngitis/epidemiology
• Pharyngitis/etiology
• Prevalence
• Students/statistics & numerical data
• Surveys and Questionnaires
• Tongue Diseases/epidemiology
• Tongue Diseases/etiology
• Tooth Erosion/epidemiology
• Tooth Erosion/etiology
• Xerostomia/epidemiology
• Xerostomia/etiology
• Young Adult

• MSS
• Multi-Survival Screening Algorithm
• esophageal cancer
• gastric cancer
• gastroesophageal cancer diagnosis
• gastroesophageal junction cancer
• methylation array-based profile
• methylation signature
• predictor
• tumor characterization
• tumor classification

• Asthma/complications
• Asthma/epidemiology
• Asthma/immunology
• Asthma/pathology
• Dermatitis, Atopic/complications
• Dermatitis, Atopic/epidemiology
• Dermatitis, Atopic/immunology
• Dermatitis, Atopic/pathology
• Eosinophilic Esophagitis/complications
• Eosinophilic Esophagitis/epidemiology
• Eosinophilic Esophagitis/immunology
• Eosinophilic Esophagitis/pathology
• Humans
• Inflammation/complications
• Inflammation/epidemiology
• Inflammation/immunology
• Inflammation/pathology
• Neoplasms/epidemiology
• Neoplasms/etiology
• Neoplasms/immunology
• Neoplasms/pathology

• K01 DK103953 NIDDK NIH HHS
• R03 DK118310 NIDDK NIH HHS
• U54 AI117804 NIAID NIH HHS
• K08 DK106444 NIDDK NIH HHS
• T32 DK007634 NIDDK NIH HHS
• R01 DK121159 NIDDK NIH HHS

• Bariatric surgery
• Esophageal cancer
• GERD
• Gastric banding
• Hiatal hernia
• LAGB

• Barrett esophagus
• diabetes
• epidemiology
• esophageal adenocarcinoma
• meta-analysis

• Adenocarcinoma/complications
• Adenocarcinoma/pathology
• Barrett Esophagus/complications
• Barrett Esophagus/pathology
• Case-Control Studies
• Diabetes Mellitus/etiology
• Diabetes Mellitus/pathology
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/pathology
• Female
• Humans
• Male
• Middle Aged

• R01 CA001833 NCI NIH HHS
• R01 CA109193 NCI NIH HHS
• R01CA116845 NIH HHS
• K23DK079291 NIH HHS
• R01CA059636 NIH HHS
• R01CA030022 NIH HHS
• I01 CX000899 CSRD VA
• U01 CA057949-03 NCI NIH HHS
• U01CA199336 NIH HHS
• R01 CA116845 NCI NIH HHS
• U01 CA199336 NCI NIH HHS
• K08 DK002697 NIDDK NIH HHS
• R37CA041530 NIH HHS
• R01DK063616 NIH HHS
• U01 CA057949 NCI NIH HHS
• U54 CA163059 NCI NIH HHS
• R01 CA030022 NCI NIH HHS
• U54CA163059 NIH HHS
• ZIA CP010220-08 Intramural NIH HHS
• R01 DK063616 NIDDK NIH HHS
• R01CA001833 NIH HHS
• K23 DK079291 NIDDK NIH HHS
• K23DK059311 NIH HHS
• P30 DK056338 NIDDK NIH HHS
• U01CA057949 NIH HHS
• R01CA109193 NIH HHS
• K23 DK059311 NIDDK NIH HHS
• K07 CA222060 NCI NIH HHS
• K08DK002697 NIH HHS

• Esophagus
• MRI
• Radiation therapy
• Radiation-induced damage

• Acute Disease
• Animals
• Cone-Beam Computed Tomography
• Esophagus/pathology
• Esophagus/radiation effects
• Feasibility Studies
• Magnetic Resonance Imaging/methods
• Mice
• Qualitative Research
• Radiation Injuries/diagnostic imaging
• Radiation Injuries/pathology

• None Elekta (SE)
• None Nine Point Medical
• ZonMw

The prediction and final survival rate of gastrointestinal cancers are dependent on the stage of disease. The ideal would be to detect those gastrointestinal lesions at early stage or even premalignant forms which are difficult to detect by conventional endoscopy with white light optical imaging as they show minimum or no changes in morphological characteristics and are thus left untreated. The introduction of molecular imaging has greatly changed the pattern for detecting gastrointestinal lesions from purely macroscopic structural imaging to the molecular level. It allows microscopic examination of the gastrointestinal mucosa with endoscopy after the topical or systemic application of molecular probes. In recent years, major advancements in endoscopic instruments and specific molecular probes have been achieved. This review focuses on the current status of endoscopic imaging and highlights the application of molecular imaging in gastrointestinal and hepatic disease in the context of diagnosis and therapy based on recently published literature in this field. We also discuss the challenges of molecular endoscopic imaging, its future directions and potential that could have a tremendous impact on endoscopic research and clinical practice in future.

• antibody labeling
• confocal endomicroscopy
• endoscopy
• ex vivo study
• in vivo imaging
• molecular imaging

• endoscopic submucosal dissection
• endoscopic treatment
• esophageal cancer
• photodynamic therapy
• squamous cell carcinomas

Barrett’s esophagus (BE) is an abnormality arising from gastroesophageal reflux disease that can progressively evolve into a sequence of dysplasia and adenocarcinoma. Progression of Barrett’s esophagus into dysplasia is monitored with endoscopic surveillance. The current surveillance standard requests random biopsies plus targeted biopsies of suspicious lesions under white-light endoscopy, known as the Seattle protocol. Recently, published evidence has shown that narrow-band imaging (NBI) can guide targeted biopsies to identify dysplasia and reduce the need for random biopsies. We aimed to assess the health economic implications of adopting NBI-guided targeted biopsy vs. the Seattle protocol from a National Health Service England perspective. A decision tree model was developed to undertake a cost-consequence analysis. The model estimated total costs (i.e. staff and overheads; histopathology; adverse events; capital equipment) and clinical implications of monitoring a cohort of patients with known/suspected BE, on an annual basis. In the simulation, BE patients (N = 161,657 at Year 1; estimated annual increase: +20%) entered the model every year and underwent esophageal endoscopy. After 7 years, the adoption of NBI with targeted biopsies resulted in cost reduction of £458.0 mln vs. HD-WLE with random biopsies (overall costs: £1,966.2 mln and £2,424.2 mln, respectively). The incremental investment on capital equipment to upgrade hospitals with NBI (+£68.3 mln) was offset by savings due to the reduction of histological examinations (-£505.2 mln). Reduction of biopsies also determined savings for avoided adverse events (-£21.1 mln). In the base-case analysis, the two techniques had the same accuracy (number of correctly identified cases: 1.934 mln), but NBI was safer than HD-WLE. Budget impact analysis and cost-effectiveness analyses confirmed the findings of the cost-consequence analysis. In conclusion, NBI-guided targeted biopsies was a cost-saving strategy for NHS England, compared to current practice for detection of dysplasia in patients with BE, whilst maintaining at least comparable health outcomes for patients.

• Adult
• Barrett Esophagus/diagnostic imaging
• Barrett Esophagus/economics
• Barrett Esophagus/pathology
• Cost Savings
• Cost-Benefit Analysis
• Disease Progression
• England
• Esophageal Neoplasms/economics
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/prevention & control
• Esophagoscopy/adverse effects
• Esophagoscopy/economics
• Esophagoscopy/methods
• Esophagus/diagnostic imaging
• Esophagus/pathology
• Female
• Humans
• Image-Guided Biopsy/economics
• Male
• Mass Screening/adverse effects
• Mass Screening/economics
• Mass Screening/methods
• Models, Economic
• Narrow Band Imaging/adverse effects
• Narrow Band Imaging/economics
• Narrow Band Imaging/methods
• Precancerous Conditions/diagnostic imaging
• Precancerous Conditions/economics
• Precancerous Conditions/pathology
• State Medicine/economics
• Young Adult