OBJECTIVE: To evaluate risk factors for dysplasia and adenocarcinoma development in nondysplastic Barrett mucosa. SUMMARY BACKGROUND DATA: The risk for patients with Barrett esophagus to develop esophageal adenocarcinoma is low, and most patients undergoing surveillance will not develop malignancy. Identification of risk factors may allow for more rational surveillance programs in which patients are stratified according to their individual risk of progressing to dysplasia and invasive adenocarcinoma. METHODS: The development of dysplasia and esophageal adenocarcinoma was studied during long-term endoscopic and histologic surveillance in 140 patients with Barrett esophagus free from dysplasia. Risk factors for progression to dysplasia and adenocarcinoma were evaluated. RESULTS: Median follow-up was 5.8 years. Forty-four patients (31.4%) developed low-grade dysplasia and 7 patients (5%) developed high-grade dysplasia or esophageal adenocarcinoma. Dysplasia development was significantly less common after antireflux surgery compared with conventional medical therapy. Low-grade dysplasia (relative risk = 5.5; 95% confidence interval, 1.1-28.6) and long duration of reflux symptoms (relative risk = 1.3; 95% confidence interval, 1.2-1.7) were independently associated with an increased risk of developing high-grade dysplasia or esophageal adenocarcinoma. CONCLUSIONS: Successful antireflux surgery protects the Barrett mucosa from developing high-grade dysplasia and esophageal adenocarcinoma, possibly by better control of reflux of gastric contents. Low-grade dysplasia is the only clinically useful risk factor that permits stratification of the surveillance intervals according to the risk of the individual patient.
OBJECTIVE: To evaluate risk factors for dysplasia and adenocarcinoma development in nondysplastic Barrett mucosa. SUMMARY BACKGROUND DATA: The risk for patients with Barrett esophagus to develop esophageal adenocarcinoma is low, and most patients undergoing surveillance will not develop malignancy. Identification of risk factors may allow for more rational surveillance programs in which patients are stratified according to their individual risk of progressing to dysplasia and invasive adenocarcinoma. METHODS: The development of dysplasia and esophageal adenocarcinoma was studied during long-term endoscopic and histologic surveillance in 140 patients with Barrett esophagus free from dysplasia. Risk factors for progression to dysplasia and adenocarcinoma were evaluated. RESULTS: Median follow-up was 5.8 years. Forty-four patients (31.4%) developed low-grade dysplasia and 7 patients (5%) developed high-grade dysplasia or esophageal adenocarcinoma. Dysplasia development was significantly less common after antireflux surgery compared with conventional medical therapy. Low-grade dysplasia (relative risk = 5.5; 95% confidence interval, 1.1-28.6) and long duration of reflux symptoms (relative risk = 1.3; 95% confidence interval, 1.2-1.7) were independently associated with an increased risk of developing high-grade dysplasia or esophageal adenocarcinoma. CONCLUSIONS: Successful antireflux surgery protects the Barrett mucosa from developing high-grade dysplasia and esophageal adenocarcinoma, possibly by better control of reflux of gastric contents. Low-grade dysplasia is the only clinically useful risk factor that permits stratification of the surveillance intervals according to the risk of the individual patient.
Authors: Johannes Lenglinger; Claudia Ringhofer; Margit Eisler; Roland Sedivy; Fritz Wrba; Johannes Zacherl; Enrico P Cosentini; Gerhard Prager; Michael Haefner; Martin Riegler Journal: Wien Klin Wochenschr Date: 2007 Impact factor: 1.704
Authors: B T Theron; H Padmanabhan; H Aladin; P Smith; E Campbell; P Nightingale; B T Cooper; N J Trudgill Journal: United European Gastroenterol J Date: 2016-02-19 Impact factor: 4.623
Authors: Claudia Ringhofer; Johannes Lenglinger; Margit Eisler; Fritz Wrba; Roland Sedivy; Johannes Zacherl; Enrico P Cosentini; Gerhard Prager; Elena Devyatko; Martin Riegler Journal: Wien Klin Wochenschr Date: 2007 Impact factor: 1.704
Authors: Daniel Vallböhmer; Paul Marjoram; Hidekazu Kuramochi; Daisuke Shimizu; Hsuan Jung; Steve R DeMeester; Daniel Oh; Parakrama T Chandrasoma; Kathleen D Danenberg; Tom R DeMeester; Peter V Danenberg; Jeffrey H Peters Journal: J Gastrointest Surg Date: 2007-09 Impact factor: 3.452