Long-term follow-up in patients with indeterminate Barrett esophagus

TY - JOUR

T1 - Long-term follow-up in patients with indeterminate Barrett esophagus

AU - Becker, V

AU - Bobardt, J

AU - Ott, R

AU - Rösch, T

AU - Meining, A

N1 - © 2013 S. Karger AG, Basel.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - BACKGROUND: Barrett esophagus (BE) is a major risk factor for adenocarcinoma of the distal esophagus. Reliable detection of BE during upper endoscopy is therefore mandatory. According to most guidelines, diagnosis of BE requires both endoscopy and histology for confirmation. However, since adenocarcinomas were also described in patients with indeterminate BE, i.e. endoscopic visible columnar metaplasia but no histological confirmation of goblet cells or vice versa, debate has risen on the risk of malignancy and the need for endoscopic surveillance in such patients.PATIENTS AND METHODS: The study was aimed to assess long-term follow-up data on 209 patients with indeterminate BE (on histopathology or endoscopy) initially examined between 1999 and 2000. Patients or referring physicians were contacted concerning the most recent endoscopic and histopathological results.RESULTS: Follow-up data could be assessed in 149/209 patients (65.1%) after a mean follow-up period of 9.4 years (SD ±2.4 years). Neoplasia was not reported for any patient. The previous endoscopic-histopathological diagnoses could be confirmed in 3 patients only. In the group with endoscopic diagnosis of BE but no histopathological confirmation, BE was described histopathologically in 1 patient during follow-up.CONCLUSION: Persistence of indeterminate BE is poor during long-term follow up. The risk of cancer appears to be negligible. Hence, surveillance of these patients appears equivocal.

AB - BACKGROUND: Barrett esophagus (BE) is a major risk factor for adenocarcinoma of the distal esophagus. Reliable detection of BE during upper endoscopy is therefore mandatory. According to most guidelines, diagnosis of BE requires both endoscopy and histology for confirmation. However, since adenocarcinomas were also described in patients with indeterminate BE, i.e. endoscopic visible columnar metaplasia but no histological confirmation of goblet cells or vice versa, debate has risen on the risk of malignancy and the need for endoscopic surveillance in such patients.PATIENTS AND METHODS: The study was aimed to assess long-term follow-up data on 209 patients with indeterminate BE (on histopathology or endoscopy) initially examined between 1999 and 2000. Patients or referring physicians were contacted concerning the most recent endoscopic and histopathological results.RESULTS: Follow-up data could be assessed in 149/209 patients (65.1%) after a mean follow-up period of 9.4 years (SD ±2.4 years). Neoplasia was not reported for any patient. The previous endoscopic-histopathological diagnoses could be confirmed in 3 patients only. In the group with endoscopic diagnosis of BE but no histopathological confirmation, BE was described histopathologically in 1 patient during follow-up.CONCLUSION: Persistence of indeterminate BE is poor during long-term follow up. The risk of cancer appears to be negligible. Hence, surveillance of these patients appears equivocal.

KW - Adenocarcinoma

KW - Barrett Esophagus

KW - Esophageal Neoplasms

KW - Esophagoscopy

KW - Female

KW - Follow-Up Studies

KW - Goblet Cells

KW - Humans

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Precancerous Conditions

KW - Prognosis

U2 - 10.1159/000353600

DO - 10.1159/000353600

M3 - SCORING: Journal article

C2 - 24080585

VL - 88

SP - 161

EP - 164

JO - DIGESTION

JF - DIGESTION

SN - 0012-2823

IS - 3

ER -