Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus - PubMed (original) (raw)
doi: 10.1136/gut.2007.142539. Epub 2008 May 6.
A Behrens, A May, L Nachbar, L Gossner, T Rabenstein, H Manner, E Guenter, J Huijsmans, M Vieth, M Stolte, C Ell
Affiliations
- PMID: 18460553
- DOI: 10.1136/gut.2007.142539
Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's oesophagus
O Pech et al. Gut. 2008 Sep.
Abstract
Objective: Endoscopic therapy is increasingly being used in the treatment of high-grade intraepithelial neoplasia (HGIN) and mucosal adenocarcinoma (BC) in patients with Barrett's oesophagus. This report provides 5 year follow-up data from a large prospective study investigating the efficacy and safety of endoscopic treatment in these patients and analysing risk factors for recurrence.
Design: Prospective case series.
Setting: Academic tertiary care centre.
Patients: Between October 1996 and September 2002, 61 patients with HGIN and 288 with BC were included (173 with short-segment and 176 with long-segment Barrett's oesophagus) from a total of 486 patients presenting with Barrett's neoplasia. Patients with submucosal or more advanced cancer were excluded.
Interventions: Endoscopic therapy.
Main outcome measures: Rate of complete remission and recurrence rate, tumour-associated death.
Results: Endoscopic resection was performed in 279 patients, photodynamic therapy in 55, and both procedures in 13; two patients received argon plasma coagulation. The mean follow-up period was 63.6 (SD 23.1) months. Complete response (CR) was achieved in 337 patients (96.6%); surgery was necessary in 13 (3.7%) after endoscopic therapy failed. Metachronous lesions developed during the follow-up in 74 patients (21.5%); 56 died of concomitant disease, but none died of BC. The calculated 5 year survival rate was 84%. The risk factors most frequently associated with recurrence were piecemeal resection, long-segment Barrett's oesophagus, no ablative therapy of Barrett's oesophagus after CR, time until CR achieved >10 months and multifocal neoplasia.
Conclusions: This study showed that endoscopic therapy was highly effective and safe, with an excellent long-term survival rate. The risk factors identified may help stratify patients who are at risk for recurrence and those requiring more intensified follow-up.
Comment in
- Upper gastrointestinal tumors.
Tytgat KM. Tytgat KM. Endoscopy. 2010 Jan;42(1):42-5. doi: 10.1055/s-0029-1215379. Epub 2009 Dec 4. Endoscopy. 2010. PMID: 19967633 No abstract available.
Similar articles
- Complete Barrett's eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma--an American single-center experience.
Chennat J, Konda VJ, Ross AS, de Tejada AH, Noffsinger A, Hart J, Lin S, Ferguson MK, Posner MC, Waxman I. Chennat J, et al. Am J Gastroenterol. 2009 Nov;104(11):2684-92. doi: 10.1038/ajg.2009.465. Epub 2009 Aug 18. Am J Gastroenterol. 2009. PMID: 19690526 - Stepwise radical endoscopic resection for eradication of Barrett's oesophagus with early neoplasia in a cohort of 169 patients.
Pouw RE, Seewald S, Gondrie JJ, Deprez PH, Piessevaux H, Pohl H, Rösch T, Soehendra N, Bergman JJ. Pouw RE, et al. Gut. 2010 Sep;59(9):1169-77. doi: 10.1136/gut.2010.210229. Epub 2010 Jun 4. Gut. 2010. PMID: 20525701 - [Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction].
von Rahden BH, Feith M, Stein HJ. von Rahden BH, et al. Zentralbl Chir. 2006 Apr;131(2):97-104. doi: 10.1055/s-2006-921551. Zentralbl Chir. 2006. PMID: 16612774 Review. German. - The role of endoscopic resection and ablation therapy for early lesions.
Gossner L. Gossner L. Best Pract Res Clin Gastroenterol. 2006;20(5):867-76. doi: 10.1016/j.bpg.2006.05.006. Best Pract Res Clin Gastroenterol. 2006. PMID: 16997166 Review.
Cited by
- Oesophageal cancer--an overview.
Schweigert M, Dubecz A, Stein HJ. Schweigert M, et al. Nat Rev Gastroenterol Hepatol. 2013 Apr;10(4):230-44. doi: 10.1038/nrgastro.2012.236. Epub 2013 Jan 8. Nat Rev Gastroenterol Hepatol. 2013. PMID: 23296250 Review. - Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma.
Rubenstein JH, Shaheen NJ. Rubenstein JH, et al. Gastroenterology. 2015 Aug;149(2):302-17.e1. doi: 10.1053/j.gastro.2015.04.053. Epub 2015 May 7. Gastroenterology. 2015. PMID: 25957861 Free PMC article. Review. - Esophageal Squamous Cell Carcinoma Patients Have an Increased Risk of Coexisting Colorectal Neoplasms.
Baeg MK, Choi MG, Jung YD, Ko SH, Lim CH, Kim HH, Kim JS, Cho YK, Park JM, Lee IS, Kim SW. Baeg MK, et al. Gut Liver. 2016 Jan;10(1):76-82. doi: 10.5009/gnl14381. Gut Liver. 2016. PMID: 25963088 Free PMC article. - Barrett's esophagus with high grade dysplasia is associated with non-esophageal cancer.
Bar N, Schwartz N, Nissim M, Fliss-Isacov N, Zelber-Sagi S, Kariv R. Bar N, et al. World J Gastroenterol. 2018 Oct 21;24(39):4472-4481. doi: 10.3748/wjg.v24.i39.4472. World J Gastroenterol. 2018. PMID: 30356981 Free PMC article. - Endoscopic submucosal dissection for malignant esophageal lesions.
Hammad H, Kaltenbach T, Soetikno R. Hammad H, et al. Curr Gastroenterol Rep. 2014;16(5):386. doi: 10.1007/s11894-014-0386-0. Curr Gastroenterol Rep. 2014. PMID: 24659252 Review.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical