Clinical Question: What is the prog...

Clinical Question: What is the prognosis for patients who have long-segment Barrett's esophagus with intestinal metaplasia?

Setting: Outpatient (specialty)

subject of attention Design: Cohort (prospective)

Synopsis: In this long-term follow-up consideration investigators enrolled 105 Dutch patients with at least 3 cm of Barrett's esophagus, no cancer or high-grade dysplasia, and specialized intestinal metaplasia in a biopsy specimen. Previous studies have shown that solely patients with specialized intestinal metaplasia are at risk for progression to cancer or high-grade dysplasia, and that this risk is greater with longer portions of Barrett's esophagus. Thus, this is a particularly high-risk subset among all patients with Barrett's esophagus.

Patients were followed for a mean of 127 years. Forty-six patients underwent couple or more repeat endoscopies; the other 59 had single in kind or no repeat endoscopies during the follow-up period. The physicians of all 105 patients were contacted and asked whether each patient was alive, whether the patient had been diagnosed with esophageal cancer, and, if he or she died, what the cause of death was. Follow-up was integral with a total of 1329 patient-years.

Although 72 patients died during the follow-up period, no other than three died of esophageal cancer. Five patients were diagnosed with high-grade dysplasia and six were diagnosed with cancer during the follow-up period, an average of 08 percent by means of year. Some patients may have died with esophageal cancer or high-grade dysplasia that was undetect because not all had regular endoscopy.

Bottom Line: Esophageal cancer is singular even in patients with lengthy segment Barrett's esophagus and intestinal metaplasia. Whether intensive endoscopic surveillance improves clinical issues is unclear. Nevertheless, endoscopic surveillance remains the standard of care in in the greatest degree countries. (Level of Evidence: 1b-)

application of mind Reference: Hage M, et al. Oesophageal cancer incidence and mortality in patients with long-segment Barrett's oesophagus after a mean follow-up of 127 years. Scand J Gastroenterol December 2004;39:1175-9 Used with permission from Ebell M Cancer in 05% by year with long-segment Barrett's. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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