title: Management of high grade dysplasia in Barrett's oesophagus with underlying oesophageal varices: A retrospective study.
abstract: BACKGROUND
  Endoscopic treatment of Barrett's oesophagus leading to high grade dysplasia with oesophageal varices may lead to bleeding complications.
  
  
  OBJECTIVE
  Estimate effectiveness of endoscopic band-ligation in oesophageal varices patients treated for high grade dysplasia, and compare to endoscopically treated non-oesophageal varices high grade dysplasia patients.
  
  
  METHODS
  Retrospective comparative study. All 8 high grade dysplasia patients with varices who were treated initially with band-ligation at Mayo Clinic between 8/1/1999 and 2/28/2014 were compared with reference group of 52 high grade dysplasia patients treated endoscopically.
  
  
  RESULTS
  One high grade dysplasia patients patient with oesophageal varices (12.5%) achieved complete remission of intestinal metaplasia defined by at least one followup endoscopy with normal biopsies, and 3 (37.5%) achieved complete remission of dysplasia defined by at least one followup endoscopy with non-dysplastic biopsies. 39 (75.0%) endomucosal resection/radiofrequency ablation patients experienced at least one followup endoscopy with normal biopsies, and 49 (94.2%) experienced non-dysplastic biopsies. Both of these endpoints occurred significantly more often in the endomucosal resection/radiofrequency ablation group compared to the high grade dysplasia with oesophageal varices group (p=0.016 and p=0.025, respectively).
  
  
  CONCLUSIONS
  High grade dysplastic Barrett's can be safely managed with band-ligation. However, resolution of Barrett's epithelium is rarely achieved with banding alone.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, USA. Electronic address: Palmer.william@Mayo.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Palmer
authors.affiliation: Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Di Leo
authors.affiliation: Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
authors.forename: Manol
authors.initials: M
authors.lastname: Jovani
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic Jacksonville, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic Jacksonville, USA.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Diehl
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic Rochester, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, USA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications*; D001706:Biopsy; D017115:Catheter Ablation / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Barrett's oesophagus; Cirrhosis; Dysplasia; Endomucosal resection; Endoscopic ultrasonography (EUS); Eradication; Oesophageal cancer; Portal hypertension