Long-term follow-up of Barrett's high-grade dysplasia

Weston, Allan P.; Sharma, Prateek; Topalovski, Margaretia; Richards, Robert J.; Cherian, Rachel; Dixon, Anita

doi:10.1111/j.1572-0241.2000.02234.x

Cited by 225 publications

(80 citation statements)

References 26 publications

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“…In three of these eight patients, EAC was diagnosed simultaneously with IM-HGD, whereas a fourth patient was discovered to have occult EAC at surgical pathology after esophagectomy. This demographic information corroborates what we already know from other studies: (1) surveillance does not alter the natural history of nondysplastic IM progression to IM-HGD and EAC, and (2) a significant proportion of patients with IM-HGD will progress to EAC or IM-HGD and EAC will be diagnosed simultaneously [7,14,20,22,23,35].…”

Section: Discussionsupporting

confidence: 89%

Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system

et al. 2006

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Complete ablation of IM-HGD without ablation of submucosa is possible using the HALO360 system. Ablation depth is dose related and limited to the muscularis mucosae. In one patient, small residual foci of IM-HGD at the edge of the ablation zone were attributable to incomplete overlap, which can be avoided. This study, together with nonesophagectomy IM-HGD trials currently underway, will identify the optimal treatment parameters for IM-HGD patients who would otherwise undergo esophagectomy or photodynamic therapy.

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Section: Discussionsupporting

confidence: 89%

Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system

et al. 2006

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“…However, these risks must be contrasted with the risk of mortality from progression to advanced cancer while patients are under surveillance. Although data on this issue are not often reported, several series have documented that this does occur in as many as 3% to 25% of these patients [8][9][10].…”

Section: Discussionmentioning

confidence: 92%

“…They also assert that when patients do progress to detectable cancer while on follow-up observation, the cancers still are diagnosed at an early curable stage [10]. However, progression to unresectable cancer at a frequency of 3% to 25% has been reported in many of the series describing outcomes of endoscopic follow-up assessment for high-grade dysplasia [8][9][10]. In some cases, this is attributable to noncompliance with the rigors of the aggressive endoscopy protocol, but in other cases, it appears to be the result of rapid tumor progression.…”

Section: Introductionmentioning

confidence: 93%

“…Surgical series report a 30% to 56% prevalence of these occult cancers in esophagectomy specimens [1][2][3][4][5]. In addition, large cohort studies of patients followed by serial endoscopy for high-grade dysplasia show that adenocarcinoma is identified ultimately in approximately 50% at 3 years and 80% at 8 years [8,9]. Together, these data suggest that most patients with high-grade dysplasia either already have or soon will have cancer.…”

Section: Introductionmentioning

confidence: 95%

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Predictive factors of coexisting cancer in Barrett’s high-grade dysplasia

et al. 2006

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“…HG-IN may originate uni-or multifocally within entirely nonneoplastic Barrett's epithelium [16][17][18][19]. Furthermore it has been shown that HG-IN is frequently already associated with synchronous invasive Barrett's carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Barrett-Ösophagus mit hochgradiger intraepithelialer Neoplasie: Beobachtung, Ablation oder Resektion?

Rahden

Stein

2007

Eur Surg

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Barrett-Ö sophagus mit hochgradiger intraepithelialer Neoplasie: Beobachtung, Ablation oder Resektion?Zusammenfassung. Grundlagen: Die Behandlung der hochgradigen intraepithelialen Neoplasie (HG-IN) im Barrett-Ö sophagus (BÖ ) wird kontrovers diskutiert.Methodik: Wir stellen die derzeit verfü gbaren Daten zur HG-IN dar und bewerten die Eignung der verschiedenen verfü gbaren Behandlungsstrategien: Beobachtung, Ablation, Resektion.Ergebnisse: HG-IN im BÖ ist eine eindeutig (prä -)maligne Lä sion, die hä ufig multifokal vorkommt und oft bereits synchron mit einem invasiven ö sophagealen Adenokarzinom vergesellschaftet ist. Die Etablierung der Diagnose ist eine Herausforderung, einerseits durch den substantiellen endoskopischen 'Sampling Error' (auch bei Anwendung neuer Technologien wie Chromo-oder Magnifikationsendoskopie) und 'Intra-=Interuntersucher Variabilitä t' des Pathologen bei der Unterscheidung verschiedener Formen der intraepithelialen Neoplasie und des frü hen invasiven Karzinoms. Hinsichtlich der Behandlungsstrategie der Wahl belegen viele Daten, dass ein onkologisch adä quater Therapieansatz gewä hlt werden sollte, der die Entfernung des gesamten prä kanzerö sen BÖ und die regionale Lymphadenektomie umfasst.Schlussfolgerungen: Die chirurgische Resektion ist Behandlungsstrategie der Wahl beim BÖ mit HG-IN. Die limitierte Resektion des ö sophagogastralen Ü bergangs ist der radikalen Ö sophagektomie, der endoskopischen Mukosarresektion, wie auch ablativen und Beobachtungsstrategien ü berlegen.Schlü sselwö rter: Barrett-Ö sophagus, hochgradige Dyplasie, hochgradige intraepitheliale Neoplasie, intestinale metaplasie, Limitierte Resektion des ö sophagogastralen Ü bergangs, niedriggradige Dysplasie, niedriggradige intraepitheliale Neoplasie, Merendino. Summary. Background: The treatment of high-grade intraepithelial neoplasia (HG-IN) within Barrett's oesophagus (BOe) is controversial.Methods: Herein we highlight current data on HG-IN and evaluate adequacy of various treatment strategies (observation, ablation, resection).Results: HG-IN within BOe has clearly (pre-)malignant character, is frequently multifocal and often already associated with synchronous invasive oesophageal (Barrett's) adenocarcinoma. Establishment of the diagnosis is challenging, due to substantial endoscopic 'sampling error' (even with new technologies like chromo-or magnification endoscopy) and 'intra-=interobserver variability' distinguishing different forms of intraepithelial neoplasia and early invasive carcinomas. Regarding the treatment of choice for this condition, there is plenty of evidence to suggest that an oncologically adequate approach should be chosen, including removal of the entire precancerous BOe and regional lymphadenectomy.Conclusions: Surgical resection is the 'treatment of choice' for BOe harbouring HG-IN. Limited resection of the oesophagogastric junction is superior to radical oesophagectomy, endoscopic mucosa resection, ablation or observational strategies.

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Long-term follow-up of Barrett's high-grade dysplasia

Abstract: Barrett's uHGD has a high risk for progressing to mHGD or cancer. Justification of an observational approach to uHGD should be discouraged. Markers of uHGD progression, as well as regression, are needed.

Cited by 225 publications

References 26 publications

Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system

Endoscopic ablation of intestinal metaplasia containing high-grade dysplasia in esophagectomy patients using a balloon-based ablation system

Predictive factors of coexisting cancer in Barrett’s high-grade dysplasia

Barrett-Ösophagus mit hochgradiger intraepithelialer Neoplasie: Beobachtung, Ablation oder Resektion?

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