TITLE

BARRETT'S OESOPHAGUS—IS SURVEILLANCE REQUIRED?

AUTHOR(S)
Gupta, S.; Fernandez, C.; Arnaout, A.; Theodossi, A.; Mendall, M.A.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA43
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: Controversy exists about the utility of a screening endoscopy programme and the value of proton pump inhibitors (PPI) in preventing the progression from metaplasia to dysplasia to cancer in Barrett's oesophagus (BO). Earlier studies to determine the risk of oesophageal adenocarcinoma in BO were conducted largely before the era of widespread usage of PPIs. We present a long term follow up study of subjects with BO, a high proportion of whom were on PPIs. Aims and Methods: The aim was to determine the efficacy of screening to detect oesophageal cancer in patients with BO in the context of high rates of PPI usage. All cases of BO diagnosed at our hospital from 1990 to 1998 were identified from a histopathology database. Case notes were retrieved and a database prepared. Patients who died during follow up had the cause of death ascertained from the Department of Public Health, Registry of Births and Deaths and Office of National Statistics. PPI usage was recorded at each follow up visit. Results: A total of 308 patients were identified of whom 35 patients did not nave intestinal metaplasia. 19 files could not be traced. Of the 273 subjects with intestinal metaplasia, 179 (65.6%) were male. Total follow up till October 31 2000 was 1145 patient years (1110 years with the untraceable files excluded). Mean age of diagnosis was 66.7±14.1 years (range 21-94 years). 136/156 (87.2%) patients on first follow up endoscopy, 74/79 (93.7%) patients on second follow up endoscopy and 28/32 (87.5%) patients on third follow up endoscopy were on PPIs. 12 (4%) oesophageal/ cardia adenocarcinomas were detected of which 9 were detectecl on first endoscopy. 3 cases were suspicious of at initial endoscopy. One of these was confirmed as adenocarcinoma 1 month and the other two 3 months later. Two of the 11 patients had high grade dysplasia. One of these was referred for treatment and is still alive while the other d ed of an unrelated cancer. 84 patients died during...
ACCESSION #
9747556

 

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