High-grade dysplasia in Barrett's oesophagus: natural history and review of clinical practice.
BACKGROUND
Management of high-grade dysplasia in Barrett's oesophagus is controversial: surgery carries an appreciable morbidity/mortality, high-grade dysplasia may not progress to cancer and endoscopic ablation is an emerging option.


OBJECTIVE
To review Barrett's oesophagus-related high-grade dysplasia management and outcome over a 10-year period.


METHODS
This was a retrospective case note review of 36 patients identified from a pathology database.


RESULTS
There were 31 men of mean age 67 years. Endoscopic surveillance identified nine. Median follow-up was 21 months. Seven patients had no further intervention because of age/comorbidity. The other 29 had repeat endoscopic biopsies, nine showing cancer (six oesophagectomized). Of the 20 remaining patients with persisting high-grade dysplasia, eight had surgery (histology showed cancer in six), seven continued endoscopic surveillance (high-grade dysplasia regressed in four) and five had 'curative' argon ablation. An intensive biopsy protocol was not followed in 55% of endoscopies. Prevalent cancers occurred in 44% with an annual incidence of 5% over 5 years. All cause mortality was 39% (14 of 36, eight of 14 from cancer).


CONCLUSIONS
Management of high-grade dysplasia was not uniform. Unsuspected cancer was common in high-grade dysplasia patients undergoing surgery but 13% regressed under surveillance. High-grade dysplasia patients have a high mortality but 43% did not die from cancer.
Thomas
T
T
Digestive Diseases Centre, University Hospitals of Leicester, Leicester, UK.
Richards
C J
CJ
de Caestecker
J S
JS
Robinson
R J
RJ
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000628:therapy*; D001706:Biopsy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011230:Precancerous Conditions / Q000473:pathology / Q000628:therapy*; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors