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Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study.
Am J Gastroenterol. 2003 Sep; 98(9):1931-9.AJ

Abstract

OBJECTIVE

Barrett's esophagus (BE) is a premalignant condition for which regular endoscopic follow-up is usually advised. We evaluated the incidence of esophageal adenocarcinoma (AC) in patients with BE and the impact of endoscopic surveillance on mortality from AC.

METHODS

A cohort of newly diagnosed BE patients was studied prospectively. Endoscopic and histological surveillance was recommended every 2 yr. Follow-up status was determined from hospital and registry office records and telephone calls to the patients.

RESULTS

From 1987 to 1997, BE was diagnosed in 177 patients. We excluded three with high-grade dysplasia (HGD) at the time of enrollment. Follow-up was complete in 166 patients (135 male, 31 female). The mean length of endoscopic follow-up was 5.5 yr (range 0.5-13.3). Low-grade dysplasia (LGD) was present initially in 16 patients (9.6%) and found during follow-up in another 24 patients. However, in 75% of cases, LGD was not confirmed on later biopsies. HGD was found during surveillance in three patients (1.8%), one with simultaneous AC; two with HGD developed AC later. AC was detected in five male patients during surveillance. The incidence of AC was 1/220 (5/1100) patient-years of total follow-up, or 1/183.6 (5/918) patient-years in subjects undergoing endoscopy. Four AC patients died, and one was alive with advanced-stage tumor. The mean number of endoscopies performed for surveillance, rather than for symptoms, was 2.4 (range 1-10) per patient. During the follow-up years the cohort had a total of 528 examinations and more than 4000 biopsies.

CONCLUSIONS

The incidence of AC in BE is low, confirming recent data from the literature reporting an overestimation of cancer risk in these patients. In our patient cohort, surveillance involved a large expenditure of effort but did not prevent any cancer deaths. The benefit of surveillance remains uncertain.

Authors+Show Affiliations

Department of Gastroenterology, National Institute for Cancer Research, Genova, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

14499768

Citation

Conio, Massimo, et al. "Long-term Endoscopic Surveillance of Patients With Barrett's Esophagus. Incidence of Dysplasia and Adenocarcinoma: a Prospective Study." The American Journal of Gastroenterology, vol. 98, no. 9, 2003, pp. 1931-9.
Conio M, Blanchi S, Lapertosa G, et al. Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. Am J Gastroenterol. 2003;98(9):1931-9.
Conio, M., Blanchi, S., Lapertosa, G., Ferraris, R., Sablich, R., Marchi, S., D'Onofrio, V., Lacchin, T., Iaquinto, G., Missale, G., Ravelli, P., Cestari, R., Benedetti, G., Macrì, G., Fiocca, R., Munizzi, F., & Filiberti, R. (2003). Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. The American Journal of Gastroenterology, 98(9), 1931-9.
Conio M, et al. Long-term Endoscopic Surveillance of Patients With Barrett's Esophagus. Incidence of Dysplasia and Adenocarcinoma: a Prospective Study. Am J Gastroenterol. 2003;98(9):1931-9. PubMed PMID: 14499768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. AU - Conio,Massimo, AU - Blanchi,Sabrina, AU - Lapertosa,Gabriella, AU - Ferraris,Roberto, AU - Sablich,Renato, AU - Marchi,Santino, AU - D'Onofrio,Vittorio, AU - Lacchin,Teresa, AU - Iaquinto,Gaetano, AU - Missale,Guido, AU - Ravelli,Paolo, AU - Cestari,Renzo, AU - Benedetti,Giorgio, AU - Macrì,Giuseppe, AU - Fiocca,Roberto, AU - Munizzi,Francesco, AU - Filiberti,Rosangela, PY - 2003/9/23/pubmed PY - 2003/11/7/medline PY - 2003/9/23/entrez SP - 1931 EP - 9 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 98 IS - 9 N2 - OBJECTIVE: Barrett's esophagus (BE) is a premalignant condition for which regular endoscopic follow-up is usually advised. We evaluated the incidence of esophageal adenocarcinoma (AC) in patients with BE and the impact of endoscopic surveillance on mortality from AC. METHODS: A cohort of newly diagnosed BE patients was studied prospectively. Endoscopic and histological surveillance was recommended every 2 yr. Follow-up status was determined from hospital and registry office records and telephone calls to the patients. RESULTS: From 1987 to 1997, BE was diagnosed in 177 patients. We excluded three with high-grade dysplasia (HGD) at the time of enrollment. Follow-up was complete in 166 patients (135 male, 31 female). The mean length of endoscopic follow-up was 5.5 yr (range 0.5-13.3). Low-grade dysplasia (LGD) was present initially in 16 patients (9.6%) and found during follow-up in another 24 patients. However, in 75% of cases, LGD was not confirmed on later biopsies. HGD was found during surveillance in three patients (1.8%), one with simultaneous AC; two with HGD developed AC later. AC was detected in five male patients during surveillance. The incidence of AC was 1/220 (5/1100) patient-years of total follow-up, or 1/183.6 (5/918) patient-years in subjects undergoing endoscopy. Four AC patients died, and one was alive with advanced-stage tumor. The mean number of endoscopies performed for surveillance, rather than for symptoms, was 2.4 (range 1-10) per patient. During the follow-up years the cohort had a total of 528 examinations and more than 4000 biopsies. CONCLUSIONS: The incidence of AC in BE is low, confirming recent data from the literature reporting an overestimation of cancer risk in these patients. In our patient cohort, surveillance involved a large expenditure of effort but did not prevent any cancer deaths. The benefit of surveillance remains uncertain. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/14499768/Long_term_endoscopic_surveillance_of_patients_with_Barrett's_esophagus__Incidence_of_dysplasia_and_adenocarcinoma:_a_prospective_study_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-9270&date=2003&volume=98&issue=9&spage=1931 DB - PRIME DP - Unbound Medicine ER -