title: Low prevalence of submucosal invasive carcinoma at esophagectomy for high-grade dysplasia or intramucosal adenocarcinoma in Barrett's esophagus: a 20-year experience.
abstract: BACKGROUND
  The rate of occult adenocarcinoma at esophagectomy in patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) has been reported to be approximately 40%. Recently, it has been suggested that this risk may be overestimated.
  
  
  OBJECTIVE
  Our purpose was to determine the rate of submucosal invasive adenocarcinoma in patients undergoing esophagectomy for BE after biopsy diagnosis of HGD or intramucosal carcinoma (IMC). A secondary aim was to identify clinical risk factors for submucosal invasive adenocarcinoma in these patients.
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All patients with preoperative BE with HGD or IMC treated with esophagectomy over a 20 year period.
  
  
  METHODS
  Esophagectomy.
  
  
  METHODS
  Submucosal invasive adenocarcinoma at esophagectomy.
  
  
  RESULTS
  Sixty patients were included (41 with preoperative HGD, 19 with preoperative IMC). The overall rate of submucosal invasive carcinoma was 6.7% (95% CI, 1.8%-16.2%) (n = 4), with a 5% rate of submucosal invasion in patients with preoperative HGD and 11% for patients with preoperative IMC. All 4 patients with submucosal invasion at esophagectomy had either nodular or ulcerated mucosa on preoperative endoscopy. The 1-year and 5-year all-cause risks of death for the entire cohort were 1.9% and 10.9%, respectively.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  The rate of submucosal invasive adenocarcinoma at esophagectomy in BE patients with HGD or IMC on biopsy is much lower than 40%. After adequate sampling and staging, patients with BE with HGD and IMC, especially those without endoscopically visible lesions, can potentially be treated by nonsurgical (local) therapies.
authors.affiliation: Division of Gastroenterology and Hepatology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Wang
authors.forename: Jason L
authors.initials: JL
authors.lastname: Hornick
authors.forename: Joe A
authors.initials: JA
authors.lastname: Sepulveda
authors.forename: Rie
authors.initials: R
authors.lastname: Mauer
authors.forename: John M
authors.initials: JM
authors.lastname: Poneros
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009361:Neoplasm Invasiveness; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors