Increased use of minimally invasive non-endoscopic tests for Barrett’s esophagus screening
Embargoed news from Annals of Internal Medicine
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
1. Increased use of minimally invasive non-endoscopic tests for Barrett’s esophagus screening could impact detection and prevention of esophageal cancer
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The authors of a new commentary from Mayo Clinic suggest that more extensive use of minimally invasive non-endoscopic tests for Barrett’s esophagus (BE) screening could impact early detection and prevention of esophageal adenocarcinoma (EAC), a particularly deadly form of cancer. This is important because BE, the only known precursor to esophageal cancer, is often asymptomatic. Their commentary is published in Annals of Internal Medicine.
BE may progress to EAC through the development of low- and high-grade dysplasia. Endoscopic treatment for dysplasia can reduce the risk for progression to cancer and endoscopic treatment of early-stage esophageal cancer significantly increase chances of long-term survival. Endoscopic screening for BE in patients with chronic reflux and other risk factors followed by endoscopic surveillance is recommended by professional societies, but it is invasive and costly and asymptomatic patients are missed by screening. As such, the authors suggest that a paradigm shift in strategies for BE screening and early detection of dysplasia or EAC is needed.
Minimally invasive non-endoscopic esophageal sampling devices currently in development are showing promise for early detection and could help to overcome the challenges associated with endoscopy. Among these, the best-studied include string-attached, capsule enclosed, compressed spherical pieces of polyurethane foam that deploy in the stomach 5 minutes after swallowing and a balloon that is inflated after swallowing and is inverted and withdrawn via an attached cord. These devices provide esophageal cytology samples, which are analyzed for biomarkers associated with BE and EAC such as methylated DNA markers. These swallowable esophageal cell collection devices can be administered by a nurse in an office setting (with procedure times ?10 minutes) and do not require sedation.
According to the authors, encouraging progress in the nonendoscopic detection of BE will potentially lead to a more complete identification of those at risk for EAC and, when paired with improved dysplasia detection and risk prognostication, could lead to meaningful advances in EAC outcomes.
2. Essay provides context to debate over use of mechanical ventilation for COVID-19
An essay from Harvard University provides context to the debate over mechanical ventilation for COVID-19 patients. The author argues that the good-faith debate that broke out over acute respiratory distress syndrome, or ARDS, and Covid-19 at the beginning of the pandemic was the product of increasing dependence on high technologies in the hospital. By learning the history of these technologies, clinicians can understand how diagnoses and treatments came to be, and what unhelpful, questionable, or obsolete assumptions those technologies carry with them. The essay is published in Annals of Internal Medicine.
The value of manual positive-pressure ventilation was first noted during the polio epidemic of 1952. This treatment dramatically improved mortality rates and paved the way for widespread use of mechanical ventilators and the expansion of intensive care units over the next decade and beyond. While ventilators aided healing in patients with some conditions, they also contributed to the emergence of ARDS as it is recognized and treated today.
By the 1980s, several researchers began to argue for the existence of a phenomenon known as ventilator-induced lung injury (VILI), which seemed to be an inevitable consequence of the treatment. If the ventilator had brought ARDS into existence, it had done the same for ventilator-induced lung injury. In the early 1990s, the formal definition of ARDS was revised to begin clinical trials of ventilatory strategies to avoid VILI. Of note, the new definition – which emphasized O2 levels – may have encouraged early intubation of COVID-19 patients, despite still having compliant, flexible lungs, likely making ventilation a poor treatment choice.
While historical knowledge does not settle the debate, it may provide valuable clinical context. The author suggests that this awareness might help scientists take a fresh look at this perplexing syndrome and encourage a more open-minded and less defensive discussion.
Also new in this issue:
The problem of conflicting guidelines
Annals On Call
Social Impacts of the COVID-19 Pandemic through Visual Art