14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Barrett esophagus: risk factors for progression to dysplasia and adenocarcinoma.

      Annals of Surgery
      Adenocarcinoma, epidemiology, pathology, surgery, Adult, Age Distribution, Aged, Barrett Esophagus, Biopsy, Needle, Disease Progression, Esophageal Neoplasms, Esophagoscopy, methods, Female, Humans, Immunohistochemistry, Incidence, Male, Middle Aged, Precancerous Conditions, Probability, Prognosis, Proportional Hazards Models, Prospective Studies, Registries, Risk Factors, Sex Distribution, Statistics, Nonparametric

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          To evaluate risk factors for dysplasia and adenocarcinoma development in nondysplastic Barrett mucosa. 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. 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. 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. 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.

          Related collections

          Author and article information

          Comments

          Comment on this article