title: Preference of endoscopic ablation over medical prevention of esophageal adenocarcinoma by patients with Barrett's esophagus.
abstract: OBJECTIVE
  Endoscopic intervention or pharmacologic inhibition of cyclooxygenase might be used to prevent progression of Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC). We investigated whether patients with BE prefer endoscopic therapy or chemoprevention of EAC.
  
  
  METHODS
  Eighty-one subjects with nondysplastic BE were given a survey that described 2 scenarios. The survey explained that treatment A (ablation), endoscopy, reduced lifetime risk of EAC by 50%, with 5% risk for esophageal stricture, whereas treatment B (aspirin) reduced lifetime risk of EAC by 50% and the risk of heart attack by 30%, yet increased the risk for ulcer by 75%. Subjects indicated their willingness to undergo either treatment A and/or treatment B if endoscopic surveillance were required every 3-5 years, every 10 years, or were not required. Visual aids were included to represent risk and benefit percentages.
  
  
  RESULTS
  When surveillance was required every 3-5 years, more subjects were willing to undergo treatment A than treatment B (78%, 63 of 81 vs 53%, 43 of 81; P < .01). There were no differences in age, sex, education level, or history of cancer, heart disease, or ulcer between patients willing to undergo treatment A and those willing to undergo treatment B. Altering the frequency of surveillance did not affect patients' willingness to undergo either treatment.
  
  
  CONCLUSIONS
  In a simulated scenario, patients with BE preferred endoscopic intervention over chemoprevention for EAC. Further investigation of the shared decision-making process regarding preventive strategies for patients with BE may be warranted.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: patrick.yachimski@vanderbilt.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yachimski
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Tonya
authors.initials: T
authors.lastname: Givens
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Eric
authors.initials: E
authors.lastname: Howard
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Tina
authors.initials: T
authors.lastname: Higginbotham
authors.affiliation: Veterans Administration Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Angie
authors.initials: A
authors.lastname: Price
authors.affiliation: Veterans Administration Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Berman
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Hosford
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Paul Menard
authors.initials: PM
authors.lastname: Katcher
authors.affiliation: Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
authors.forename: Elissa
authors.initials: E
authors.lastname: Ozanne
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Katherine
authors.initials: K
authors.lastname: Perzan
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Chin
authors.initials: C
authors.lastname: Hur
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications*; D018890:Chemoprevention / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D055815:Young Adult
keywords: COX Inhibitor; Esophageal Cancer; Patient Choice; Surgery