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High‐grade dysplasia in Barrett's oesophagus: natural history and review of clinical practice
Author(s) -
Thomas T.,
Richards C. J.,
Caestecker J. S.,
Robinson R. J.
Publication year - 2005
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2005.02401.x
Subject(s) - medicine , dysplasia , cancer , comorbidity , surgery , natural history , incidence (geometry) , optics , physics
Summary Background: Management of high‐grade dysplasia in Barrett's oesophagus is controversial: surgery carries an appreciable morbidity/mortality, high‐grade dysplasia may not progress to cancer and endoscopic ablation is an emerging option. Aim: To review Barrett's oesophagus‐related high‐grade dysplasia management and outcome over a 10‐year period. Methods: This was a retrospective case note review of 36 patients identified from a pathology database. Results: There were 31 men of mean age 67 years. Endoscopic surveillance identified nine. Median follow‐up was 21 months. Seven patients had no further intervention because of age/comorbidity. The other 29 had repeat endoscopic biopsies, nine showing cancer (six oesophagectomized). Of the 20 remaining patients with persisting high‐grade dysplasia, eight had surgery (histology showed cancer in six), seven continued endoscopic surveillance (high‐grade dysplasia regressed in four) and five had ‘curative’ argon ablation. An intensive biopsy protocol was not followed in 55% of endoscopies. Prevalent cancers occurred in 44% with an annual incidence of 5% over 5 years. All cause mortality was 39% (14 of 36, eight of 14 from cancer). Conclusions: Management of high‐grade dysplasia was not uniform. Unsuspected cancer was common in high‐grade dysplasia patients undergoing surgery but 13% regressed under surveillance. High‐grade dysplasia patients have a high mortality but 43% did not die from cancer.