Value of endoscopic surveillance in the detection of neoplastic change in Barrett's oesophagus

Abstract

Fifty-six patients with Barrett's oesophagus diagnosed between 1977 and 1986 were prospectively studied by 6-monthly endoscopic surveillance and biopsy. During follow-up to-date, four patients have developed high-grade dysplasia and three have adenocarcinoma of the oesophagus. Two of the adenocarcinomas were preceded by progressively severe dysplastic changes but in the third no dysplasia had been previously detected. The incidence of adenocarcinoma was 1 per 56 patient-years of follow-up. Changes in symptomatology or gross endoscopic appearances were usually absent, even after adenocarcinoma had developed, indicating that biopsy is essential for early diagnosis. The high risk of malignant change makes endoscopic surveillance advisable in all patients with Barrett's oesophagus.

Multiple Management Modalities in Esophageal Cancer: Epidemiology, Presentation and Progression, Work-up, and Surgical Approaches

“…Small studies have suggested that surveillance can identify neoplasms that are at an earlier stage and, thus, potentially curable [35][36][37][38]. However, Koshy, Esiashvilli, Landry et al 140 these hopeful results may be confounded by lead time bias, length time bias, and pseudodisease [37].…”

Unresolved Issues in Barrett’s Esophagus in the New Millennium

“…Despite the alarming increase in the incidence of esophageal adenocarcinoma the precise incidence of adenocarcinoma in patients with Barrett's esophagus is uncertain, with rates varying from 1/52 to 1/285 years of follow-up (table 4) [59,61,[66][67][68][69][70][71]. All recent studies suggest a much lower risk than what was previously thought [61,70,71].…”

Longitudinal Study of Insulin-like Growth Factor, Insulin-like Growth Factor Binding Protein-3, and their Polymorphisms: Risk of Neoplastic Progression in Barrett's Esophagus

“…This disease affects f40% of American adults (4). Each year, f0.5% to 1% of persons with Barrett's esophagus progress to esophageal adenocarcinoma, a rate that is 30 to 40 times higher than that in the general population (5)(6)(7)(8)(9)(10). Recent research has indicated that abnormalities, such as aneuploidy and tetraploidy, identify a particular high-risk subset of Barrett's esophagus patients (11)(12)(13).…”