Winthrop-University Hospital, Mineola, NY, USA.
Am J Med. 2010 May;123(5):462-7. doi: 10.1016/j.amjmed.2009.10.013.
Barrett's surveillance for dysplasia is recommended, but few studies have documented the benefit of endoscopic surveillance for dysplasia or cancer.
Using a retrospective study design, we aim to demonstrate the impact of a Barrett's surveillance program on the stage of esophageal adenocarcinoma and identify factors for progression of metaplasia to cancer.
The Institutional Review Board at Veterans Affairs Connecticut Healthcare approved the study. We report a retrospective review of a prospectively followed Barrett's cohort in a surveillance program and compared their outcome with patients with a new diagnosis of esophageal adenocarcinoma, identified at the same center between 1999 and 2005.
There were 248 patients with Barrett's esophagus entered into a surveillance program from 1999 to 2005. During the surveillance period of 987 patient-years, 5 (0.5% patient-year) patients developed esophageal adenocarcinoma. During the same period, 46 patients were diagnosed with new-onset esophageal adenocarcinoma outside of our surveillance program. Only 5% of these patients had a history of gastroesophageal reflux disease. There were 248 patients who underwent a mean number of 2.7+/-1.7 upper endoscopic procedures, with 26 (10%) patients developing dysplasia. Compared with nonsurveillance, more patients had early stage of cancer in the surveillance group (P <.001). All 5 patients with cancer diagnosed from Barrett's esophagus surveillance endoscopy were alive, compared with 20 of 46 (43%) patients with cancer diagnosed outside of the surveillance program. The length of Barrett's segment >3 cm was found to be associated with development of dysplasia, P=.004 (odds ratio 1.2; 95% confidence interval, 1.07-1.34).
Patients with Barrett's esophagus undergoing endoscopic surveillance benefit from early-stage cancer diagnosis. Progression to adenocarcinoma is low, but long-segment and high-grade dysplasias have an increased risk of cancer. A significant number of patients with newly diagnosed esophageal adenocarcinoma do not complain of gastroesophageal reflux disease and are therefore not investigated for Barrett's esophagus nor entered into surveillance. Patients and physicians can use this information in making a decision about surveillance.
巴雷特食管的监测推荐用于监测异型增生，但很少有研究记录内镜监测异型增生或癌症的益处。
采用回顾性研究设计，旨在证明巴雷特食管监测计划对食管腺癌分期的影响，并确定异型增生进展为癌症的因素。
退伍军人事务部康涅狄格州医疗保健机构的机构审查委员会批准了该研究。我们报告了一项在监测计划中对前瞻性随访的巴雷特食管队列进行的回顾性分析，并将其结果与 1999 年至 2005 年间在同一中心诊断的新发食管腺癌患者进行了比较。
1999 年至 2005 年间，共有 248 例巴雷特食管患者进入监测计划。在 987 患者年的监测期间，5 例（0.5%患者年）患者发生食管腺癌。在此期间，46 例患者在我们的监测计划之外被诊断为新发食管腺癌。这些患者中只有 5%有胃食管反流病病史。有 248 例患者接受了平均 2.7+/-1.7 次上消化道内镜检查，26 例（10%）患者出现异型增生。与非监测相比，监测组中更多患者处于癌症早期（P<.001）。所有 5 例在巴雷特食管监测内镜下诊断为癌症的患者均存活，而在监测计划之外诊断为癌症的 46 例患者中有 20 例（43%）存活。发现巴雷特食管段长度>3 cm 与异型增生的发生相关，P=.004（比值比 1.2；95%置信区间，1.07-1.34）。
接受内镜监测的巴雷特食管患者受益于早期癌症诊断。进展为腺癌的风险较低，但长节段和高级别异型增生的癌症风险增加。大量新发食管腺癌患者没有胃食管反流病的症状，因此没有接受巴雷特食管的检查，也没有被纳入监测。患者和医生可以利用这些信息来决定是否进行监测。
