Endoscopic Surveillance of Barrett's Esophagus: A Cost-Effectiveness Comparison With Mammographic Surveillance for Breast Cancer

Jm, Streitz; Fh, Ellis; Rl, Tilden; Rv, Erickson

doi:10.1111/j.1572-0241.1998.00275.x

Cited by 102 publications

(27 citation statements)

References 21 publications

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“…The risks of subsequent cancer formation in medically or surgically treated patients are shown in tables 6 and 7. Similar cancer risks have been demonstrated in other papers [29][30][31][32]. Ortiz et al [17] reported the development of cancer in 1 patient of each group so that the prevalence of malignancy was 3.7% in the conservatively treated group and 3.1% in the surgically treated group.…”

Section: Resultssupporting

confidence: 64%

Medical and Surgical Evaluation of Barrett’s Esophagus and Barrett’s Cancer

et al. 2003

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Objective: This study reviews the development of Barrett’s esophagus in patients with gastroesophageal reflux disease. Here we evaluate the progression of the disorder into esophageal adenocarcinoma in patients with Barrett’s esophagus under treatment, and the effectiveness of current medical or surgical therapy regarding mucosal regression or progression. Methods: A MEDLINE search was performed to analyze data published in English between 1980 and 2002. Results: Despite successful surgery, Barrett’s esophagus developed in 5.8–18.9% of patients with gastroesophageal reflux disease. The rate was higher in patients receiving medical therapy (11.1–33.8%). In long-term follow-up studies the mucosal changes (length of Barrett’s mucosa, histological malformations) were reported to progress in 13.8–40.7% of patients after medical therapy and in 3.4–15.3% after surgical intervention. The risk of developing esophageal carcinoma on grounds of Barrett’s esophagus was 1.3–4.6 and 0–8.1% in patients receiving medical and surgical treatment, respectively. In the published studies, the rate of complete regression of Barrett’s esophagus following surgery varied between 0 and 26.4%. Discussion: Long-term follow-up studies confirm the histological progression in Barrett’s esophagus. Therefore, the current medical or surgical therapies do not prevent malignant transformation of the columnar epithelial lining of the esophagus. However, their combination may delay progression and cancer formation.

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Section: Resultssupporting

confidence: 64%

Medical and Surgical Evaluation of Barrett’s Esophagus and Barrett’s Cancer

et al. 2003

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“…However, these analyses are subject to confounding factors such as lead and length time bias, and it remains to be established conclusively if surveillance is beneficial. Cost benefit analyses suggest that the cost of detecting an esophageal adenocarcinoma in an endoscopic surveillance program is similar to the cost of detecting breast cancer by mammography (31).…”

Section: Barrett's Esophagus and Risk Of Esophageal Adenocarcinomamentioning

confidence: 99%

Biomarkers of Esophageal Adenocarcinoma and Barrett’s Esophagus

2004

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The rising incidence and poor prognosis of esophageal adenocarcinoma in the Western world have intensified research efforts into earlier methods of detection of this disease and its relationship to Barrett's esophagus. The progression of Barrett's esophagus to adenocarcinoma has been the focus of particular scrutiny, and a number of potential tissue and serum-based disease biomarkers have emerged. The epidemiology and pathogenesis of esophageal adenocarcinoma are outlined. Tissue biomarkers allowing risk stratification of Barrett's are reviewed as well as strategies currently being used to discover novel biomarkers that will facilitate the early detection of esophageal adenocarcinoma. Finally, the uses of biomarkers as predictive tests for targeted treatments and as surrogate endpoints in chemoprevention trials are considered.

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“…Although the study was not designed to determine the optimum interval between endoscopies, these results indicate that surveillance every 5 years would have increased the number of interval cancers diagnosed at a more advanced stage. Furthermore, recent clinical studies based on existing surveillance programmes have demonstrated that endoscopic surveillance of Barrett's oesophagus compares favourably with screening mammography for the detection of early breast cancer and faecal occult blood testing for the detection of colonic cancer 8,29 .…”

Section: Discussionmentioning

confidence: 99%