Is Barrett's Esophagus a predictor of neoplasia or not?
Abstract
Background. Active attention drawn to the problem of Barrett's esophagus as a risk factor of esophageal adenocarcinoma has led to redundancy in the evaluation of changes in the mucosa of the
esophagus.
Aim. Rationalizing of the change strategy of endoscopic diagnostics, follow-up and treatment
of patients with Barrett's esophagus.
Materials and methods. Over the period of 2007–2015 Barrett's esophagus has been diagnosed
in 114 patients during upper endoscopy with high-resolution, high-definition endoscopes.
In 93 (81.6%) of them different methods of virtual chromoscopy were used, in 87 (76.3%) patients
biopsy of 3 different records was done. Another 12 patients have been follown-up since 1995, the
examinations were performed without expert-class endoscopes, therefore those patients were not
included in the main group.
Study design. Retrospective non-randomized study with continuous renewal of the data bases
while accumulating clinical supervisions and including long-term results of dynamic evaluation of
patients’ condition. Level of evidence II.
Results. According to the histological examination data just in 1 (1.16%) out of 87 patients high
grade dysplasia was detected and in 1 (1.16%) esophageal adenocarcinoma was found. Both patients underwent surgery. In 73 (83.9%) cases gastric or intestinal metaplasia without dyspla-
sia was detected, in 11 (12.6%) patients low grade dysplasia was found, in 1 patient (1.16%)
the diagnosis of Barret’s esophagus was not confirmed. Endoscopic treatment was performed
in 19 patients, including argon-plasma coagulation in 17, endoscopic mucosal resection in 2.
For 92 patients only drug therapy was administered. Neither the patients of the main group, nor the
remaining 12 patients, which have been follown-up since 1995, had extension of Barret’s esophagus
in length, expansion of intestinal metaplasia or intensity of dysplasia, esophageal adenocarcinoma
has developed not in a single patient.
Conclusion. Despite the steady growth of the incidence of esophageal adenocarcinoma in
full set population, cancer never develops in most patients with Barrett's esophagus. In our
opinion Barrett's esophagus probably should not be considered as an obligate precancerous
condition.
Keywords:Barrett's esophagus, columnar-celled metaplasia, intestinal metaplasia, dysplasia, esophageal adenocarcinoma, high resolution and high definition videoendoscopy, narrow-band imaging (NBI), flexile spectral imaging color enhancement (FICE), chromoscopy, argon-plasma coagulation, endoscopic mucosal resection
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (2): 21–28.
DOI: 10.24411/2308-1198-2017-00029
Received: 20.12.2016. Accepted: 19.04.2017.
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