Low prevalence of submucosal invasive carcinoma at esophagectomy for high-grade dysplasia or intramucosal adenocarcinoma in Barrett's esophagus: a 20-year experience

Wang, Victor S.; Hornick, Jason L.; Sepulveda, Joe A.; Mauer, Rie; Poneros, John M.

doi:10.1016/j.gie.2008.05.013

Cited by 56 publications

(25 citation statements)

References 28 publications

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“…This is not only because of the significant risk of progression to OAC but also because up to 40% of patients with HGD may already harbor occult cancer in the Barrett's segment [11], although subsequent studies suggest this rate is much lower [12]. Even in specialist high-volume centers this operation carries a high mortality rate of 2-5% and subsequent morbidity of up to 40% [13,14].…”

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confidence: 99%

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

et al. 2017

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Aim:The aim was to evaluate the cost-effectiveness of endoscopic eradication therapy (EET) with combined endoscopic mucosal resection and radiofrequency ablation for the treatment of high-grade dysplasia (HGD) arising in patients with Barrett's esophagus compared with endoscopic surveillance alone in the UK. Materials & methods:The cost-effectiveness model consisted of a decision tree and modified Markov model. A lifetime time horizon was adopted with the perspective of the UK healthcare system. Results: The base case analysis estimates that EET for the treatment of HGD is cost-effective at a GB£20,000 cost-effectiveness threshold compared with providing surveillance alone for HGD patients (incremental cost-effectiveness ratio: GB£1272). Conclusion: EET is likely to be a cost-effective treatment strategy compared with surveillance alone in patients with HGD arising in Barrett's esophagus in the UK. Barrett's esophagus (BE) is a precancerous state that can develop into esophageal adenocarcinoma (OAC). BE exists in most patients in a metaplastic state and carries a very low risk of progression to invasive neoplasia and OAC in the region of 0.12-0.5% per year [1,2]. The 2013 British Society of Gastroenterology (BSG) guidelines advise that, in those patients with BE in whom there is no neoplasia, surveillance is recommended for those fit for endoscopy [3]. This is based on existing evidence from published studies which show that surveillance correlates with early-stage cancer diagnosis and likely improved survival from other cancers [4][5][6]. Recent work from the ProBar study group examined data from the Dutch cancer registry. They compared survival of patients with BE with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population. They found that OAC was diagnosed at an earlier stage during BE surveillance than in the general population. However, the survival of patients with BE with neoplastic progression was not significantly worse than those of patients without neoplastic progression, and was similar to survival of patients with stage 0 or stage 1 OAC in the general population [7]. In patients with OAC, the prognosis is poor with just over 15% patients being alive at 5 years [8].Current UK surveillance guidelines [3] recommend that patients with BE undergo endoscopy every 2-5 years. In some patients, no surveillance is recommended due to the negligible risk for cancer progression. The intervals are dependent on the length of BE and presence of intestinal metaplasia at the index endoscopy. However, in a minority of patients with BE there is a molecular and pathological transformation through various dysplastic stages to mucosal dysplasia and cancer and then finally invasive disease where it Cost-effectiveness analysis of endoscopic eradication therapy for treatment of highgrade dysplasia in Barrett's esophagus

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confidence: 99%

Cost–effectiveness analysis of endoscopic eradication therapy for treatment of high-grade dysplasia in Barrett’s esophagus

et al. 2017

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“…Early EAC, defined as that limited to the muscularis mucosa (T1), does not normally metastasize to LNs [43] and consequently, early-stage cancers, £T1, carry an excellent prognosis with a greater than 90% 5-year survival [44]. Unfortunately, the number of tumors detected at this stage is low (<1%) [42].…”

Section: The Challenge Of Early Diagnosismentioning

confidence: 99%

Strategies to improve outcomes in esophageal adenocarcinoma

Cowie

Noble

Underwood

2014

Expert Review of Anticancer Therapy

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“…Visible lesions in patients with dysplastic Barrett esophagus are associated with higher risk of invasive carcinoma (85,96) and should be treated with a tissueacquiring modality so these lesions can be appropriately resected and staged histologically (97).…”

Section: Tissue Adquiring Techniquesmentioning

confidence: 99%