TITLE

Literature around the world

AUTHOR(S)
Wang, Kenneth W.
PUB. DATE
December 2003
SOURCE
American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2799
SOURCE TYPE
Academic Journal
DOC. TYPE
Other
ABSTRACT
This is an interesting review of the experience of the surgical group at Johns Hopkins University with esophagectomy for patients with Barrett's esophagus with high grade dysplasia. There were a total of 60 patients reported in this review who underwent resection between 1982 and 2001. All of these patients did not have endoscopically identifiable cancer. The article reviewed the surgical principals for treatment of high grade dysplasia, which included the need for histological review of the high grade dysplasia before embarking on any therapy. The authors favored using trans-hiatal esophagectomy because it accessed Ni lymph nodes and guaranteed the ability of the surgeon to achieve a comfortable margin of squamous mucosa above the columnar Barrett's epithelium, and the cervical anastomosis decreased the chance of possible leaks. The study reported that this approach was taken in 82% of their patients. The author compared their experience with Barrett's esophagus between 1982 and 1994 with 30 patients with their experience from 1994 to 2001 in another 30 patients. The patients had similar gender, ethnicity, and ages. Interestingly, the mortality rate in the first 30 patients was 3.3%, but in the most recent period no patients died from the operation. Some of this improvement in mortality seemed to be due to the initiation of a step-wise approach to managing these patients. Another finding was that the incidence of endoscopically occult cancers decreased from 43% in the earlier period to 16.7% in the most recently treated groups. The study concluded that surgical therapy was an option in the management of Banett's esophagus, but that recent studies had demonstrated that the risk of cancer progression may have been overestimated and that endoscopic surveillance should also be considered.
ACCESSION #
15182437

 

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