Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal reflux

The role of smoking and alcohol in metaplasia and cancer risk in Barrett's columnar lined oesophagus.

“…The middle aged or elderly patient who presents with CLO and a heavy smoking history, however, is already at increased risk of developing adenocarcinoma, a risk not reversed by anti-reflux surgery. 55 Smokers and ex-smokers make up a subgroup at increased risk for development of adenocarcinoma in Barrett's oesophagus; those patients with specialised type metaplasia and who may benefit from surgical intervention warrant regular endoscopy and biopsy whereas nonsmokers are at low risk.…”

“…Of those who smoked, patients with CLO had . a median smoking history of 15 pack years (range 2-60 pack years) which was less than both the severe oesophagitis (median 45*5, range 5-150 pack years; p<0-001) and adenocarcinoma groups (median 55 25, range 4-200 pack years) (p<0-001) (Fig 2). Severe oesophagitis patients (median 38-5, range 27-55 years) and adenocarcinoma patients had similar long histories of smoking, both of which were greater than CLO * patients (p<0O003) (Fig 3).…”

Adenocarcinoma in Barrett's esophagus

“…Among patients with benign Barrett's esophagus, 3 had continued reflux in spite of surgical and medical therapy, one of whom developed high grade dysplasia and eventual carcinoma after three years of follow-up. The role of continued reflux in promoting malignant degeneration is challenged by several reports in the literature describing the occurrence of carcinoma after antireflux repair [37,38]. These reports generally suffer from lack of objective evidence documenting reflux control.…”

Endoscopic ablation of Barrett's esophagus using argon plasma coagulation: a prospective study after fundoplication

“…Thus some cancers, particularly those that presented during the first 5 years after surgery, may not represent progression to cancer after surgical therapy, but, rather, may have begun to develop prior to the surgery 8 . However there are several reports of detection of cancer in Barrett's esophagus in a variable period after antireflux surgery, from 9 months to 9 years 9–12 …”

“…8 However there are several reports of detection of cancer in Barrett's esophagus in a variable period after antireflux surgery, from 9 months to 9 years. [9][10][11][12] The ultimate therapy would be the regeneration of squamous epithelium in patients with Barrett's esophagus using an endoscopic method of ablation. Combined with antireflux surgery, this may become the standard in preventing esophageal adenocarcinoma arising in Barrett's esophagus.…”