Document Detail


Barrett's esophagus: a retrospective analysis of 13 years surveillance.
MedLine Citation:
PMID:  18205769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIMS: The incidence of esophageal adenocarcinoma has increased significantly. Barrett's esophagus (BE), a known precursor, has a high prevalence but only few patients with this condition progress to malignancy--surveillance and screening programs are controversial and lack proven efficacy. This retrospective analysis reviews the 13-year outcome for patients entered into a surveillance program. METHODS: Data from patients with histologically proven Barrett's esophagus (1992-2003) that participated in a surveillance program were identified and analyzed retrospectively until 2005. RESULTS: 404/536 patients had Barrett's esophagus confirmed histologically of which 212 (53%) were followed in a surveillance program (mean 3.95 years per patient). This resulted in 749 gastroscopies (3.5/patient). Histologically, Barrett's mucosa was seen in 54%, low-grade dysplasia in 18%, ulcerations in 9%, high-grade dysplasia in 2%. No metaplasia was seen in 13%, no biopsy was obtained in 3%. Nine of 212 patients (4.3%) under surveillance developed esophageal cancer; two presented with symptoms, requiring gastroscopy outside the surveillance program (1/2 was operated successfully, one had advanced disease). In seven asymptomatic patients, cancer was detected on routine endoscopy; curative esophagectomy was performed in six. All patients who developed cancer were male and all but one patient had dysplasia or ulcerations on index endoscopy. CONCLUSION: During 13 years of Barrett's surveillance, 88% of all adenocarcinoma occurred in a subset of only 11% patients. To stratify surveillance for Barrett's esophagus, programs could focus on male patients with dysplasia or ulcerations on index endoscopy. However, the cost-effectiveness of this remains unproven.
Authors:
Victoria Switzer-Taylor; Martin Schlup; Ralf Lübcke; Vicki Livingstone; Michael Schultz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-17
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  23     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-10-15     Completed Date:  2009-01-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1362-7     Citation Subset:  IM    
Affiliation:
Department of Medical and Surgical Sciences, Medicine Section, University of Otago Medical School, Dunedin, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / pathology*,  surgery
Aged
Aged, 80 and over
Barrett Esophagus / pathology*
Biopsy
Disease Progression
Esophageal Neoplasms / pathology*,  surgery
Esophagectomy
Esophagoscopy
Esophagus / pathology*
Female
Gastroscopy
Humans
Male
Mass Screening* / methods
Middle Aged
Mucous Membrane / pathology
Patient Selection
Precancerous Conditions / pathology*
Program Evaluation
Retrospective Studies
Risk Assessment
Risk Factors
Sex Factors
Ulcer / pathology
Comments/Corrections
Comment In:
J Gastroenterol Hepatol. 2008 Sep;23(9):1311-2   [PMID:  18853989 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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