High grade dysplasia still is not an indication for surgery in patients with Barrett's esophagus: An update

Schnell, Thomas; Sontag, S.J.; Chejfec, G.; Kurucar, C.; O’Çonnell, Susan; Levine, Gwendolyn J.; Karpf, Janne; Adelman, K.; Brand, L; Seidel, J.

doi:10.1016/s0016-5085(98)81139-6

Cited by 10 publications

(11 citation statements)

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“…Over 18 months of follow-up, 7 of the surveillance patients developed esophageal adenocarcinoma and were treated with esophagectomy; none had lymphatic metastases. Similar findings were reported by Schnell et al [37]. In their study population, 8 of 42 patients with high-grade dysplasia developed adenocarcinoma during surveillance follow-up of 7.5 years.…”

Section: Management Of Barrett's Esophagus With High-grade Dysplasiasupporting

confidence: 91%

Medical Therapy versus Antireflux Surgery in Barrett’s Esophagus: What Is the Best Therapeutic Approach?

Alexander¹,

Hinder²

2000

Dig Dis

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We conducted a review of the literature comparing medical treatment with antireflux surgery in patients with Barrett’s esophagus (BE). In particular, we wanted to assess the efficacy of medical and surgical therapies in preventing the progression of Barrett’s epithelium to dysplasia or adenocarcinoma of the esophagus. In general, few BE patients show complete regression of BE epithelium following medical or surgical therapy. The incidence of developing dysplasia or cancer following surgical therapy appears to be less than with medical therapy; however, there is an insufficient number of current, randomized controlled studies to confirm this. Surveillance of BE is required regardless of treatment. This review suggests that there may be a trend in support of surgery being somewhat better than medical therapy in the prevention of BE progression and adenocarcinoma. We suggest that patients with BE should be considered for antireflux surgery – in particular, certain subgroups of BE patients.

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Section: Management Of Barrett's Esophagus With High-grade Dysplasiasupporting

confidence: 91%

Medical Therapy versus Antireflux Surgery in Barrett’s Esophagus: What Is the Best Therapeutic Approach?

Alexander¹,

Hinder²

2000

Dig Dis

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“…but there is interobserxer v ariation in the diagynosis of HGD (Reid et al 1988) and not all patients with HGD A ill dexvelop cancer (Schnell et al 1996).…”

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confidence: 99%

Allelotype analysis of oesophageal adenocarcinoma: loss of heterozygosity occurs at multiple sites

Dolan

Garde²,

Gosney³

et al. 1998

Br J Cancer

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Summary Deletions of tumour-suppressor genes can be detected by loss of heterozygosity (LOH) studies, which were performed on 23 cases of adenocarcinoma of the oesophagus, using 120 microsatellite prmers coverng all non-acrocentric autosomal chromosome arms.The chromosomal arms most frequently demonstrating LOH were 3p (644% of tumours). 5q (45%), 9p (52%), lip (61%) Correspondence to: JK Field studies can lead to the identification of tumour-suppressor genes that are inactix ated in the metaplasia-dxsplasia-carcinoma progression. and may therefore be useful as biomarkers of future carcinogenesis in patients w-ith Barrett's metaplasia and dx splasia undergoing endoscopic surveillance. Previous alleleotype analx ses have detected LOH in more than 40%c of oesophageal adenocarcinomas on chromosome arms lp. 4q. 5q. 9p. 13q. 17p and 18q (Barrett et al. 1996a andHammoud et al. 1996). These allelotype studies AWere undertak-en Awith 43 and 39 microsatellite primers respectixely. We have performed the most comprehensive genomic study of oesophageal adenocarcinoma to date. coxering all of the non-acrocentnrc chromosome arms w-ith 120 microsatellite pnrmers. enabling identification of putatiVe tumour-suppressor gene sites in oesophageal adenocarcinoma. MATERIALS AND METHODS PatientsTwentv-three cases of adenocarcinoma of the oesophagus diagnosed betmeen 1992 and 1996 were studied. Twenty of these patients were male and their mean age xxas 68 y-ears. At present. six of these patients are alix e w ith no signs of recurrent disease. DNA extractionTissue from the tumour and from normal gastric mucosa were obtained from endoscopic biopsies and from surgical resections. snapped frozen in liquid nitroaen and stored at -70 C. Areas of tumour containincg minimal stromal cells wxere microdissected and DNA extracted from the microdissected tissues usinc the Nucleon II extraction kit (Scotlab).950

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“…Some authors recommend esophagectomy for these patients [49,54] while others advocate continued endoscopic surveillance until biopsy evidence of esophageal cancer is found [51,52,[55][56][57]. The proponents of esophagectomy argue that the high prevalence of associated invasive carcinoma in patients with high-grade dysplasia justifies resection.…”

Section: Barrett's Esophagusmentioning

confidence: 99%

“…The proponents of esophagectomy argue that the high prevalence of associated invasive carcinoma in patients with high-grade dysplasia justifies resection. The basis for this concern are reports indicating that invasive carcinoma was found in 33 to 74% of patients who had esophagectomy for persistent high-grade dysplasia [48,49,57]. The proponents of endoscopic surveillance, however, argue that only 20 to 26% of high-grade dysplasia patients develop adenocarcinoma after a median followup of 12 to 24 months [58,59], and that up to 80% of patients with high-grade dysplasia did not develop adenocarcinoma over a follow-up period of 156 patient-years [58].…”

Section: Barrett's Esophagusmentioning

confidence: 99%

“…The Mayo Clinic group has reported a correlation of the density of highly dysplastic glands (focal vs. diffuse) that seemed to predict the development of invasive cancer in their Barrett's high-grade dysplasia patients [53]. Schnell et al [57] have also reported extraordinary results in 1,099 patients with Barrett's esophagus followed with endoscopic surveillance for 5 to 7 years. This study found an incidence of progression in patients with Barrett's high-grade dysplasia to invasive cancer in only 16%, despite nearly 80% of patients being diagnosed with dysplasia at some point in the study.…”

Section: Barrett's Esophagusmentioning

confidence: 99%

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Photodynamic Therapy for Mucosal Esophageal Adenocarcinoma and Dysplastic Barrett’s Esophagus

Wolfsen

2002

Dig Dis

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Photodynamic therapy is a novel endoscopic technique that combines a photosensitizer and laser light to destroy target cells. Photodynamic therapy has been used in Europe, North Africa and Japan to treat esophageal neoplasms and dysplastic Barrett’s esophagus. This paper summarizes the available published experience of photodynamic therapy for the treatment of each esophageal cancer and Barrett’s esophagus. These studies suggest that photodynamic therapy is a promising modality for esophageal mucosal disease. More long-term studies, however, are needed to document the efficacy of photodynamic therapy in reducing the morbidity and mortality from esophageal cancer for patients with high-grade dysplasia and early adenocarcinoma in Barrett’s esophagus.

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High grade dysplasia still is not an indication for surgery in patients with Barrett's esophagus: An update

Cited by 10 publications

References 0 publications

Medical Therapy versus Antireflux Surgery in Barrett’s Esophagus: What Is the Best Therapeutic Approach?

Medical Therapy versus Antireflux Surgery in Barrett’s Esophagus: What Is the Best Therapeutic Approach?

Allelotype analysis of oesophageal adenocarcinoma: loss of heterozygosity occurs at multiple sites

Photodynamic Therapy for Mucosal Esophageal Adenocarcinoma and Dysplastic Barrett’s Esophagus

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