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Barrett's oesophagus
J F Bartlesman1, W Hameeteman, G N Tÿtgat
1Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands.
Summary
Barrett's oesophagus (CLO) is a condition linked to acid reflux. Patients with CLO face a significantly increased risk of developing esophageal adenocarcinoma, highlighting the need for monitoring.
Area of Science:
- Gastroenterology
- Oncology
Background:
- Barrett's oesophagus, or columnar lined epithelium (CLO), is a metaplastic change in the oesophagus.
- It affects 15% of patients experiencing reflux oesophagitis.
- CLO is associated with excessive gastro-oesophageal reflux.
Purpose of the Study:
- To investigate the natural history of Barrett's oesophagus.
- To determine the incidence of dysplasia and adenocarcinoma in CLO patients.
- To assess the outcomes of surgical treatment for early esophageal cancer.
Main Methods:
- A cohort of 115 patients with CLO was studied.
- Dysplasia assessment was performed on CLO patients.
- Fifty CLO patients underwent annual endoscopic surveillance.
- Cancer incidence and patient survival rates were recorded.
Main Results:
- Dysplasia was identified in 46% of CLO patients, with 13.9% having moderate or severe dysplasia.
- The incidence of adenocarcinoma was 1 in 52 patient-years, representing a 125-fold excess risk.
- A dysplasia-carcinoma sequence was observed in five patients who developed cancer.
- Surgical treatment for early adenocarcinoma resulted in 100% survival for 24-70 months, with 12% postoperative mortality.
Conclusions:
- Barrett's oesophagus carries a substantial risk of progression to esophageal adenocarcinoma.
- Annual endoscopic surveillance is crucial for detecting dysplasia and early-stage cancer.
- Surgical intervention for early esophageal cancer in CLO patients offers a high survival rate.