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Comparative risk of recurrence of dysplasia and carcinoma after endoluminal eradication therapy of high-grade dysplasia versus intramucosal carcinoma in Barrett’s esophagus
- Source :
- GASTROINTESTINAL ENDOSCOPY, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- Background: Endoscopic therapy is the preferred approach for the management of Barrett's esophagus (BE) patients with high-grade dysplasia (HGD) and intramucosal carcinoma (IMC). Little is known about outcome differences in patients with HGD versus IMC. Objective: To determine and compare the rate of recurrent dysplasia or neoplasia in patients with HGD or IMC undergoing endoscopic therapy. Design: Retrospective cohort study. Patients: A total of 246 BE patients with either HGD or IMC referred for endoscopic therapy. Intervention: Patients underwent EMR and/or ablation therapy with the goal of complete eradication of all dysplasia/neoplasia and intestinal metaplasia (CE-IM). Patients were assigned to either the HGD or IMC group based on highest pathology grade at the start of therapy. Main Outcome Measurements: Complete eradication and recurrence of IM and/or HGD/neoplasia were assessed among patients with HGD versus IMC. Only patients with CE-IM (documented eradication of all dysplasia/neoplasia and IM on a single endoscopy) were included for analysis of recurrence rates and risk factors. Results: CE-IM was achieved in 113 of 135 patients (83.7%) with HGD and in 84 of 111 patients (75.7%) with IMC (P = . 16). Overall recurrence rates of dysplasia or neoplasia after CE-IM were similar in both groups (HGD, 8.0% vs IMC, 9.5%; P = . 44; relative risk, 1.2; 95% confidence interval, 0.5-3.0) and remained similar in patients with 5 years of surveillance after CE-IM (HGD, 13.5% vs IMC, 11.4%; P = . 53; relative risk, 0.85; 95% confidence interval, 0.3-2.7). Limitations: Retrospective, observational study and evolution of endoscopic modalities and experience. Conclusion: Endoluminal therapy can successfully achieve eradication of IM and dysplasia or neoplasia in BE patients with HGD and IMC at comparable rates. There were no differences in the rates of recurrent HGD/IMC in the 2 groups.
- Subjects :
- Adult
Male
medicine.medical_specialty
Esophageal Neoplasms
education
Adenocarcinoma
Gastroenterology
Barrett Esophagus
Interquartile range
Internal medicine
Carcinoma
Humans
Medicine
Radiology, Nuclear Medicine and imaging
Esophagus
Aged
Retrospective Studies
business.industry
Intestinal metaplasia
Retrospective cohort study
Middle Aged
medicine.disease
Combined Modality Therapy
digestive system diseases
surgical procedures, operative
medicine.anatomical_structure
Photochemotherapy
Dysplasia
Relative risk
Barrett's esophagus
Catheter Ablation
Female
Esophagoscopy
Neoplasm Recurrence, Local
business
Precancerous Conditions
Subjects
Details
- ISSN :
- 00165107
- Volume :
- 81
- Database :
- OpenAIRE
- Journal :
- Gastrointestinal Endoscopy
- Accession number :
- edsair.doi.dedup.....e335796ad3780f20658d6ae1199654f7