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Barrett's esophagus: A retrospective analysis of 13 years surveillance
Author(s) -
SwitzerTaylor Victoria,
Schlup Martin,
Lübcke Ralf,
Livingstone Vicki,
Schultz Michael
Publication year - 2008
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2008.05311.x
Subject(s) - medicine , esophagus , dysplasia , barrett's esophagus , endoscopy , malignancy , intestinal metaplasia , retrospective cohort study , incidence (geometry) , adenocarcinoma , gastroenterology , biopsy , esophageal cancer , esophagectomy , asymptomatic , esophageal disease , cancer , surgery , physics , optics
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.