Endoscopic surveillance of Barrett's Esophagus. Personal experience

The possible progression of Barrett's Esophagus (BE) to carcinoma is well established: the incidence of cancer in BE is about 1.9-10% or 1/52-1/441 patients/year with a risk up to 30-125 times the normal population. Endoscopic surveillance can detect esophageal adenocarcinomas when they are early and curable. The purpose of endoscopic and histologic surveillance in patients with BE is to follow its evolution in order to characterize possible affiliation to a neoplastic risk group.

From 1998 to 2000 we have endoscopically identified 12 patients with EB, histologically confirmed: 9 males and 3 females, with a M/F ratio of 3:1 and an average of 45.25 years.

During the endoscopic and histologic follow-up have observed the sequence from intestinal metaplasia with a low-grade dysplasia in one patient, confirmed after 2 months of treatment with double-dose pump inhibitor (PPI), to intestinal metaplasia with a high-grade dysplasia on biopsy samples done after vital staining with Lugol. So the patient had an endoscopic mucosal ablation, because he rejected esophagectomy. In the other patients without dysplasia, we used prokinetic drugs and PPI and we involved them in a follow-up every 2/3 years.

Histological grading of dysplasia is currently the most important parameter used to follow-up patients with EB: the guidelines suggest a periodic endoscopic surveillance, from six months to 2 or 5 years, according to higher or lower risk of carcinoma arising, because there is no medical or surgical therapy able to decrease cancer risk.