Thomas, T.; Richards, C.J.; de Caestecker, J.; Robinson, R.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA32
Academic Journal
Background: Management of HGD in Barrett's remains controversial. Aim: To review management and outcome of HGD from three hospitals in one district. Methods: Case record study. Patients with dysplasia identified from pathology database. All HGD verified by at least two upper Gl pathologists and those with coincident adenocarcinoma (AC) with HGD excluded. Results: 99 cases of dysplasia identified; 36 had HGD arising in Barrett's mucosa, M/F 31/5, mean age 67 (range 34-95). 9/36 (25%) were identified during Barrett's surveillence. 7 had no further interventions due to age and comorbidity. On repeat endoscopy and biopsy of the remaining 29 (usually within 3 months), 9 had intramucosal AC and are not further considered. Of the remaining 20, 16 had persisting HGD and 4 became and remained negative for dysplasia (mean follow up 17.2 months). Of the 16 with persisting HGD, 8 had oesophagectomy of which 6 had AC on operative histology. At a mean follow up of 18.7 months, 6 patients were disease free. There were no immediate (30 day) postoperative deaths; 3 died (2-47 months after surgery), 2 of unrelated causes and one of metastatic AC. 5 were treated with argon ablation of which 2 had nodules and/or ulcers in the Barrett's segment. In 4/5 the Barrett's segment was ablated; absence of HGD was confirmed histologically in 2 (both originally had HGD in "flat" mucosa) who remained disease free (mean FU 10 months); 2/5 developed metastatic AC of whom 1 has died. The final 3/16 continued to have surveillance: 2 developed AC (I death) and 1 died of an unrelated cause. In summary: 15 of 36 (42%) of patients with biopsy proven HGD, have underlying AC either on resection or on early rebiopsy. A further 4 developed AC during surveillance (median 17 months, range 4-64). A small proportion of HGD regress (4/36-11%). Conclusions: Oesophagectomy remains the treatment of choice in HGD because a high proportion have coincident AC. Argon ablation can be effective in a proportion of...


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