Long-term nonsurgical management of Barrett's esophagus with high-grade dysplasia

被引:425
作者
Schnell, TG
Sontag, SJ
Chejfec, G
Aranha, G
Metz, A
O'Connell, S
Seidel, UJ
Sonnenberg, A
机构
[1] US Dept Vet Affairs, Vet Affairs Edward Hines Jr Hosp, Dept Med, Hines, IL 60141 USA
[2] US Dept Vet Affairs, Vet Affairs Edward Hines Jr Hosp, Dept Pathol, Hines, IL 60141 USA
[3] US Dept Vet Affairs, Vet Affairs Edward Hines Jr Hosp, Dept Med, Hines, IL 60141 USA
[4] Loyola Univ, Stritch Sch Med, Maywood, IL 60153 USA
[5] Dept Vet Affairs, Dept Med, Albuquerque, NM USA
关键词
D O I
10.1053/gast.2001.25065
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
(Background & Aims) under bar: Surgical resection of the esophagus is frequently recommended for Barrett's high-grade dysplasia (HGD) without cancer, (Methods) under bar: During a 20-year period, patients were diagnosed and observed through an organized surveillance program at the Hines Veterans Affairs Hospital. The program was supported by Hines VA and organized and managed by 2 endoscopists using preestablished endoscopic criteria. (Results) under bar: Barrett's esophagus was diagnosed in 1099 patients, and 36,251 esophageal mucosal specimens were reviewed. Seventy-nine of 1099 patients (7.2%) initially had HGD (34 prevalent) or subsequently developed HGD (45 incident) without evidence of cancer, Of the 75 HGD patients who remained without detectable cancer after the 1 year of intensive searching, 12 developed cancer (16%) during a mean 7.3-year surveillance period: 11 of the 12 who were compliant were considered cured with surgical or ablation therapy. Cancer did not develop in the remaining 63 HGD patients during the surveillance period. (Conclusions) under bar: HGD without cancer in Barrett's esophagus follows a relatively benign course in the majority of patients. In the patients who eventually progress to cancer during regular surveillance, surgical resection is curative. Surveillance endoscopies with biopsy is a valid and safe follow-up strategy for Barrett's patients who have HGD without cancer.
引用
收藏
页码:1607 / 1619
页数:13
相关论文
共 19 条
[1]   HIGH-GRADE DYSPLASIA IN THE COLUMNAR-LINED ESOPHAGUS [J].
ALTORKI, NK ;
SUNAGAWA, M ;
LITTLE, AG ;
SKINNER, DB .
AMERICAN JOURNAL OF SURGERY, 1991, 161 (01) :97-100
[2]   Impact of hospital volume on operative mortality for major cancer surgery [J].
Begg, CB ;
Cramer, LD ;
Hoskins, WJ ;
Brennan, MF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (20) :1747-1751
[3]   RISING INCIDENCE OF ADENOCARCINOMA OF THE ESOPHAGUS AND GASTRIC CARDIA [J].
BLOT, WJ ;
DEVESA, SS ;
KNELLER, RW ;
FRAUMENI, JF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 265 (10) :1287-1289
[4]  
Edwards MJ, 1996, ANN SURG, V223, P585, DOI 10.1097/00000658-199605000-00014
[5]   Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett's esophagus with high-grade dysplasia [J].
Falk, GW ;
Rice, TW ;
Goldblum, JR ;
Richter, JE .
GASTROINTESTINAL ENDOSCOPY, 1999, 49 (02) :170-176
[6]  
HAMILTON SR, 1985, BARRETTS ESOPHAGUS P, P2937
[7]   COMPLICATIONS OF DIAGNOSTIC GASTROINTESTINAL ENDOSCOPY [J].
HART, R ;
CLASSEN, M .
ENDOSCOPY, 1990, 22 (05) :229-233
[8]   Barrett's esophagus with high-grade dysplasia - An indication for prophylactic esophagectomy [J].
Heitmiller, RF ;
Redmond, M ;
Hamilton, SR .
ANNALS OF SURGERY, 1996, 224 (01) :66-71
[9]   Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma [J].
Lagergren, J ;
Bergström, R ;
Lindgren, A ;
Nyrén, O .
NEW ENGLAND JOURNAL OF MEDICINE, 1999, 340 (11) :825-831
[10]   AN ENDOSCOPIC BIOPSY PROTOCOL CAN DIFFERENTIATE HIGH-GRADE DYSPLASIA FROM EARLY ADENOCARCINOMA IN BARRETTS-ESOPHAGUS [J].
LEVINE, DS ;
HAGGITT, RC ;
BLOUNT, PL ;
RABINOVITCH, PS ;
RUSCH, VW ;
REID, BJ .
GASTROENTEROLOGY, 1993, 105 (01) :40-50