Toward More Efficient Surveillance of Barrett’s Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer
| Autor: | Ann Schloithe, Peter A. Bampton, Mats Lindblad, David I. Watson, Jeff Bull, George C. Mayne, Louisa G. Gordon, Gang Chen, Robert J. Fraser, Tim Bright, Piers A.C. Gatenby |
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| Rok vydání: | 2016 |
| Předmět: |
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medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Risk Assessment Cohort Studies Barrett Esophagus 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Esophagus Watchful Waiting Aged Aged 80 and over business.industry Australia Intestinal metaplasia Middle Aged medicine.disease Cell Transformation Neoplastic medicine.anatomical_structure Dysplasia 030220 oncology & carcinogenesis Relative risk Barrett's esophagus Cohort Adenocarcinoma Female 030211 gastroenterology & hepatology Surgery Quality-Adjusted Life Years business Precancerous Conditions Follow-Up Studies |
| Zdroj: | World Journal of Surgery. 41:1023-1034 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/s00268-016-3819-0 |
| Popis: | Endoscopic surveillance of Barrett’s esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought. The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified individuals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk individuals. During 2067 person-years of follow-up of 640 patients, 17 individuals progressed to HGD or EAC (annual IR 0.8%). Individuals with columnar-lined esophagus (CLE) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE |
| Databáze: | OpenAIRE |
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