[Impact of endoscopic surveillance of Barrett's esophagus on survival of patients with esophageal adenocarcinoma].
In an attempt to reduce mortality from oesophageal adenocarcinoma, it has been recommended to enroll patients with Barrett's oesophagus 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 the outcome of Barrett's adenocarcinoma. From November 1992 to December 2000, 328 patients with histologically proven oesophageal adenocarcinoma were referred to our department. One hundred of these patients had Barrett's adenocarcinoma. In 12 (12%) patients, cancer was discovered during endoscopic surveillance for Barrett's metaplasia. The prevalence of gastro-oesophatgeal reflux disease in the Barrett's group was 38.8% versus 8.1% (P < 0.01) of non-Barrett's patients. In the surveyed group, there were 9 (75%) early stage tumours (Tis-1N0), versus 10 (11.4%, P < 0.01) in the non-surveyed patients. Three out of five surveyed patients operated on for high grade dysplasia proved to have invasive carcinoma in the oesophagectomy specimen. All surveyed patients were alive after a median follow-up period of 50 months; the median survival in the non-surveyed group was 24 +/- 3 months (P < 0.01). Endoscopic surveillance of Barrett's oesophagus allows early detection of malignant degeneration and better long-term survival than in non-surveyed patients.
Incarbone
Raffaello
R
Dipartimento di Scienze Chirurgiche, Università degli Studi di Milano, Istituto Policlinico San Donato, Milano.
Bonavina
Luigi
L
Bassi
Fabio
F
Peracchia
Alberto
A
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology; D001706:Biopsy; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000401:mortality; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors