Endoscopic Surveillance for Premalignant Esophageal Lesions: A Community-Based Multicenter, Prospective Cohort Study

How should extra‐large Lugol‐unstained lesions of the esophagus be treated? Results from a population‐based cohort study

“…The reasons for this recommendation were as follows: (1) The cumulative incidence of SDA was as high as 76.92% within a median of 7 years, and 61.54% of the individuals with extra‐large LULs would be identified as prevalent cases by targeted biopsy and histologic analysis (Table S3). (2) Among those not graded as SDA at baseline screening, 40.00% would eventually progress to SDA during a median of 7 years (Table S3), which was much higher than the progression rate of 7.44% reported for people with mild‐to‐moderate dysplasia based on a 7‐year multicentric community‐based surveillance cohort 25 …”

“…T A B L E 1 (Continued) dysplasia based on a 7-year multicentric communitybased surveillance cohort. 25 For individuals with LUL size of 16-20 mm, the cumulative incidence of SDA was 55.88%, with a prevalence rate of 41.18% and the proportion of non-SDA participants developing incident SDA during a median of 7 years being 25.00% (Table S3). As a result, intensive endoscopic surveillance should be recommended for these individuals.…”

Long-term esophageal cancer risk and distinct surveillance intervals after a single endoscopy screening: a multicentre population-based cohort study

“…8 The previous cohort studies in different populations in China have provided supportive evidence for this recommendation. 18 , 23 In our previous cohort analysis of surveillance endoscopy data from this EC screening programme, we demonstrated that the median time to develop severe dysplasia or esophageal squamous cell carcinoma (ESCC) was approximately 2.39 years after the detection of mild-moderate dysplasia during a median follow-up time of 6.95 years. 18 Findings from Feicheng in China also supported a screening interval of 2–3 years for patients with mild and moderate dysplasia.…”

“…All UGI endoscopic examinations and biopsies with iodine staining were conducted by experts according to the protocols for endoscopic examination and pathological diagnosis in our programme, which were formulated based on the official endoscopy protocol for screening and early detection and treatment. 18 Briefly, after the entire esophagus was visually examined, biopsy samples were collected from suspicious lesions, fixed in 10–13% formaldehyde, embedded in paraffin, and stained with haematoxylin and eosin. Two experienced pathologists independently reviewed the biopsy samples, and diagnostic discrepancies were adjudicated by consultation or resolved through discussion with a third pathologist.…”

“…A free endoscopy re-examination by our programme has been provided since 2012. 18 In addition, patients with positive findings who were diagnosed with severe dysplasia, carcinoma in situ, intramucosal carcinoma, submucosal carcinoma, or invasive carcinoma were recommended to receive appropriate treatment according to the severity of the lesions ( Supplementary Fig. S1 ).…”