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High-grade dysplasia in Barrett s oesophagus: natural history and review of clinical practice Thomas T; Richards CJ; de Caestecker JS; Robinson RJAliment Pharmacol Ther 2005[Mar]; 21 (6): 747-55BACKGROUND: Management of high-grade dysplasia in Barrett's oesophagus is controversial: surgery carries an appreciable morbidity/mortality, high-grade dysplasia may not progress to cancer and endoscopic ablation is an emerging option. AIM: To review Barrett's oesophagus-related high-grade dysplasia management and outcome over a 10-year period. METHODS: This was a retrospective case note review of 36 patients identified from a pathology database. RESULTS: There were 31 men of mean age 67 years. Endoscopic surveillance identified nine. Median follow-up was 21 months. Seven patients had no further intervention because of age/comorbidity. The other 29 had repeat endoscopic biopsies, nine showing cancer (six oesophagectomized). Of the 20 remaining patients with persisting high-grade dysplasia, eight had surgery (histology showed cancer in six), seven continued endoscopic surveillance (high-grade dysplasia regressed in four) and five had 'curative' argon ablation. An intensive biopsy protocol was not followed in 55% of endoscopies. Prevalent cancers occurred in 44% with an annual incidence of 5% over 5 years. All cause mortality was 39% (14 of 36, eight of 14 from cancer). CONCLUSIONS: Management of high-grade dysplasia was not uniform. Unsuspected cancer was common in high-grade dysplasia patients undergoing surgery but 13% regressed under surveillance. High-grade dysplasia patients have a high mortality but 43% did not die from cancer.|Adenocarcinoma/pathology/*therapy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Barrett Esophagus/pathology/*therapy[MESH]|Biopsy[MESH]|Esophageal Neoplasms/pathology/*therapy[MESH]|Esophagectomy/methods[MESH]|Esophagus/*pathology[MESH]|Female[MESH]|Humans[MESH]|Laser Coagulation/methods[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Staging/methods[MESH]|Precancerous Conditions/pathology/*therapy[MESH]|Proton Pump Inhibitors[MESH]|Retrospective Studies[MESH]|Survival Analysis[MESH]|Treatment Outcome[MESH] |
