High-grade dysplasia in Barrett's oesophagus: natural history and review of clinical practice
Autor: | Cathy Richards, Titus Thomas, J S de Caestecker, R J Robinson |
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Rok vydání: | 2005 |
Předmět: |
Adult
Male medicine.medical_specialty Esophageal Neoplasms Biopsy medicine.medical_treatment Adenocarcinoma Barrett Esophagus Esophagus medicine Humans Pharmacology (medical) Aged Neoplasm Staging Retrospective Studies Aged 80 and over Laser Coagulation Hepatology business.industry Esophageal disease Gastroenterology Cancer Proton Pump Inhibitors Retrospective cohort study Middle Aged medicine.disease Survival Analysis Comorbidity Surgery Esophagectomy Treatment Outcome medicine.anatomical_structure Dysplasia Female business Precancerous Conditions |
Zdroj: | Alimentary Pharmacology and Therapeutics. 21:747-755 |
ISSN: | 1365-2036 0269-2813 |
DOI: | 10.1111/j.1365-2036.2005.02401.x |
Popis: | 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. |
Databáze: | OpenAIRE |
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