Outcome of esophageal adenocarcinoma detected during endoscopic biopsy surveillance for Barrett's esophagus.
BACKGROUND
In an attempt to reduce mortality from esophageal adenocarcinoma, it has been recommended to enroll patients with Barrett's esophagus in endoscopic surveillance programs in order to detect malignant degeneration at an early and possibly curable stage. The aim of this study was to assess the impact of endoscopic biopsy surveillance on outcome of Barrett's adenocarcinoma.


METHODS
Between November 1992 and June 2000, 312 patients with histologically proven esophageal adenocarcinoma were referred to our department. Ninety-seven of these patients had Barrett's adenocarcinoma. In 12 (12.2%) patients, cancer was discovered during endoscopic surveillance for Barrett's metaplasia.


RESULTS
The prevalence of gastroesophageal reflux disease in the Barrett's group was 38.8% versus 8% (p < 0.01) in non-Barrett's patients. In the surveyed group, there were 9 (75%) early stage tumors (Tis-1/N0) versus 9 (10.6%, p < 0.01) in the nonsurveyed patients. Three of 5 surveyed patients operated on for high-grade dysplasia proved to have invasive carcinoma in the esophagectomy specimen. All surveyed patients were alive at a median follow-up of 48 months; the median survival in the nonsurveyed group was 24 +/- 3 months (p < 0.01).


CONCLUSIONS
Endoscopic surveillance of Barrett's esophagus provides early detection of malignant degeneration and a better long-term survival than in nonsurveyed patients.
Incarbone
R
R
Department of Surgical Sciences, University of Milan, Ospedale Maggiore di Milano, IRCCS, Via F. Sforza 35, 20122 Milan, Italy.
Bonavina
L
L
Saino
G
G
Bona
D
D
Peracchia
A
A
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D001706:Biopsy / Q000379:methods; D003949:Diagnostic Techniques, Surgical; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods; D015995:Prevalence; D016896:Treatment Outcome