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Barrett's high grade dysplasia versus intramucosal adenocarcinoma

Christina L Greene, Stephanie G Worrell, Stephen E Attwood, Parakrama Chandrasoma, Kenneth Chang, Tom R DeMeester, Reginald V Lord, Elizabeth Montgomery, Oliver Pech, John Vallone, Michael Vieth, Kenneth K Wang, Steven R DeMeester
INTRODUCTION: Endoscopic therapy has revolutionized the treatment of Barrett's esophagus with high-grade dysplasia (HGD) or intramucosal adenocarcinoma by allowing preservation of the esophagus in many patients who would previously have had an esophagectomy. This paradigm shift initially occurred at high-volume centers in North America and Europe but now is becoming mainstream therapy. There is a lack of uniform guidelines and algorithms for the management of these patients. Our aim was to review important concepts and pitfalls in the endoscopic management of superficial esophageal adenocarcinoma...
April 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ioana Smith, Michel Kahaleh
Esophagectomy has been the traditional therapy for high-grade dysplasia and intramucosal cancer. Though surgery can completely resect the cancer and the affected lymph nodes, it carries significant morbidity and mortality (often exceeds 2%). New developments in endoscopy have provided less-invasive therapies that can also be used to stage tissue invasion of cancer; they include esophageal mucosal resection (EMR) and endoscopic submucosal dissection. Additional endoscopic therapies include photodynamic therapy, radiofrequency ablation (RFA) and argon plasma coagulation...
January 2015: Expert Review of Gastroenterology & Hepatology
Kimberly S Grant, Steven R DeMeester, Vanessa Kreger, Daniel Oh, Jeffrey A Hagen, Parakrama Chandrasoma, Tom R DeMeester
OBJECTIVES: Surveillance endoscopy has been recommended for patients with Barrett's esophagus; however, recent studies have questioned the importance owing to the new, lower, estimates of the rate of progression of Barrett's esophagus to cancer. The aim of the present study was to compare the tumor stage, survival, and frequency of esophageal preservation in patients who presented with progression of Barrett's esophagus within a surveillance program versus those who presented with prevalent disease...
July 2013: Journal of Thoracic and Cardiovascular Surgery
Nicholas G Hirst, Louisa G Gordon, David C Whiteman, David I Watson, Jan J Barendregt
BACKGROUND AND AIM:   Several health economic evaluations have explored the cost-effectiveness of endoscopic surveillance for patients with non-dysplastic Barrett's esophagus, with conflicting results. By comparing results across studies and highlighting key methodological and data limitations a platform for future, more rigorous analyses, can be developed. METHODS:   A systematic literature review was undertaken of studies evaluating cost-effectiveness of surveillance for non-dysplastic Barrett's esophagus...
February 2011: Journal of Gastroenterology and Hepatology
Jörg Zehetner, Steven R DeMeester, Jeffrey A Hagen, Shahin Ayazi, Florian Augustin, John C Lipham, Tom R DeMeester
BACKGROUND: Esophagectomy has been the traditional therapy for high-grade dysplasia and intramucosal adenocarcinoma. New endoscopic approaches allow treatment of these lesions with esophageal preservation. The aim of this study was to compare the outcome of endoscopic therapy with esophagectomy for high-grade dysplasia and intramucosal cancer. METHODS: A retrospective review was performed of all patients treated for high-grade dysplasia or intramucosal adenocarcinoma from 2001 to April 2010...
January 2011: Journal of Thoracic and Cardiovascular Surgery
Jo-Etienne Abela, James J Going, John F Mackenzie, Margaret McKernan, Sylvia O'Mahoney, Robert C Stuart
AIMS: To compare detection of Barrett's dysplasia and adenocarcinoma by systematic versus nonsystematic surveillance biopsy protocols. METHODS: Upper GI consultation and open-access endoscopy are provided jointly at Glasgow Royal Infirmary by medical and surgical teams. The surgical team adopted annual systematic four-quadrant biopsy Barrett's surveillance in 1995. The medical team continued annual Barrett's surveillance with nonsystematic biopsy until 2004. We compare detection of Barrett's dysplasia and esophageal adenocarcinoma in unselected patients by these two biopsy strategies over 10 yr...
April 2008: American Journal of Gastroenterology
A H Ormsby, R E Petras, W H Henricks, T W Rice, L A Rybicki, J E Richter, J R Goldblum
BACKGROUND AND AIMS: When to perform oesophagectomy for neoplastic progression in Barrett's oesophagus is controversial. Some resect for high grade dysplasia whereas others defer treatment until intramucosal adenocarcinoma is diagnosed. Interobserver agreement for a diagnosis of high grade dysplasia or intramucosal adenocarcinoma remains unknown and may have therapeutic implications. METHODS: Histological slides from 75 oesophagectomy specimens with high grade dysplasia or T(1) adenocarcinoma were blindly reviewed by two gastrointestinal pathologists and one general surgical pathologist, and classified as high grade dysplasia, intramucosal adenocarcinoma, or submucosal adenocarcinoma...
November 2002: Gut
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