Endoscopic follow-up of Barrett's esophagus : protocol and implications
Journal | Volume 63 - 2000 |
Issue | Fasc.1 - Symposium |
Author(s) | D. De Looze |
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Department of gastroenterology, University Hospital Gent, Belgium. |
The purpose of endoscopic surveillance in Baffett's esophagus is to detect dysplasia and to diagnose carcinoma in an early, treatable stage. Prospective trials that study the efficacy of a surveillance program in reducing mortality from esophageal adenocarcinoma are lacking. Retrospective studies have shown a significantly better outcome in patients with esophageal cancer that is detected during a surveillance program. Obviously, surveillance is only indicated for those patients fit enough to undergo esophagectomy if high-grade dysplasia (HGD) or malignancy is detected. There is no consensus upon what to do with HGD : some recommend esophagectomy when HGD is diagnosed, because an important proportion of these patients host an adenocarcinoma; others feel that histological proof of malignancy should be established before esophagectomy is proposed. Dysplasia is not a uniform process, causing sampling problems. Using a strict biopsy protocol is helpful to differentiate HGD from carcinoma, but contradictory results about this type of rigorous biopsy protocol have been published. Most groups propose four biopsy specimens, in a circular fashion, from every 2 cm of the Barreff-epithelium, with additional biopsies from any mucosal abnormality. Patients with long-segment Barrett's esophagus need endoscopic surveillance, even if they underwent antireflux surgery. At this moment there are not enough data to support a systematic surveillance of patients with short-segment's Barrett's esophagus. The following endoscopic strategy can be proposed. No dysplasia : surveillance every 2 years. Low-grade dysplasia: surveillance every year ; in these cases it is recommended to repeat four-quadrant biopsies at I cm interval if numerous biopsies reveal dyspiasia to detect foci of HGD/cancer. Higb-grade dysplasia : repeat immediately four-quadrant biopsies at 1 cm interval ; if HGD is confirmed esophagectomy is advised to a patient with acceptable operative risk. Ablation therapy remains experimental. |
© Acta Gastro-Enterologica Belgica. |