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Endoscopy 2002; 34(8): 604-610
DOI: 10.1055/s-2002-33236
Original Article
© Georg Thieme Verlag Stuttgart · New York

Intraepithelial High-Grade Neoplasia and Early Adenocarcinoma in Short-Segment Barrett’s Esophagus (SSBE): Curative Treatment Using Local Endoscopic Treatment Techniques

A.  May 1 , L.  Gossner 1 , O.  Pech 1 , H.  Müller 2 , M.  Vieth 3 , M.  Stolte 3 , C.  Ell 1
  • 1Department of Internal Medicine II, HSK Wiesbaden, Germany
  • 2Institute of Pathology, Wiesbaden, Germany
  • 3Institute of Pathology, Bayreuth, Germany
Further Information

Publication History

Submitted 30 November 2001

Accepted after Revision 19 March 2002

Publication Date:
12 August 2002 (online)

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Background and Study Aims: In recent years, short-segment Barrett’s esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation.
Patients and Methods: Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett’s adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments.
Results: Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 ± 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 ± 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett’s adenocarcinoma (this was the patient who underwent esophageal resection).
Conclusions: The malignant potential of short-segment Barrett’s esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett’s esophagus.

References

  • 1 Spechler S J, Zeroogian J M, Antonioli D A. Prevalence of metaplasia at the gastro-oesophageal junction.  Lancet. 1994;  344 1533-1536
    CrossrefPubMedSearch in Google Scholar
  • 2 Weston A P, Krmpotich P, Cherian R. et al . Short segment Barrett’s esophagus: clinical and histological features, associated endoscopic findings, and association with gastric intestinal metaplasia.  Am J Gastroenterol. 1996;  91 981-986
    PubMedSearch in Google Scholar
  • 3 Johnston M H, Hammond A S, Laskin W, Jones D M. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy.  Am J Gastroenterol. 1996;  91 1507-1511
    PubMedSearch in Google Scholar
  • 4 Sharma P, Morales T G, Sampliner R E. Short segment Barrett’s esophagus: the need for standardization of the definition and of endoscopic criteria.  Am J Gastroenterol. 1998;  93 1033-1036
    PubMedSearch in Google Scholar
  • 5 Nandukar S, Talley N J. Barrett’s esophagus: the long and the short of it.  Am J Gastroenterol. 1999;  94 30-40
    CrossrefPubMedSearch in Google Scholar
  • 6 Hirota W K, Loughney T M, Lazas D J. et al . Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data.  Gastroenterology. 1999;  116 277-285
    CrossrefPubMedSearch in Google Scholar
  • 7 Donahue D, Navab F. Significance of short-segment Barrett’s esophagus.  J Clin Gastroenterol. 1997;  25 480-484
    PubMedSearch in Google Scholar
  • 8 Sharma P, Morales T G, Bhattacharyya A. et al . Dysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up.  Am J Gastroenterol. 1997;  92 2012-2016
    PubMedSearch in Google Scholar
  • 9 Weston A P, Krmpotich P T, Cherian R. et al . Prospective long-term endoscopic and histological follow-up of short segment Barrett’s esophagus: comparison with traditional long segment Barrett’s esophagus.  Am J Gastroenterol. 1997;  92 407-413
    PubMedSearch in Google Scholar
  • 10 Rudolph R E, Vaughan T L, Storer B E. et al . Effect of segment length on risk for neoplastic progression in patients with Barrett’s esophagus.  Ann Intern Med. 2000;  132 612-620
    PubMedSearch in Google Scholar
  • 11 Gossner L, May A, Pech O. et al . Chromoendoscopy for the detection of dysplasia or mucosal cancer in Barrett’s esophagus [abstract].  Gastrointest Endosc. 2000;  51 AB120 (3537)
    PubMedSearch in Google Scholar
  • 12 Watanabe H, Jass J R, Sobin L H. Histological typing of oesophageal and gastric tumors. 2nd edn. Berlin; Springer 1990
    Search in Google Scholar
  • 13 Schlemper R J, Riddell R H, Kato Y. et al . The Vienna classification of gastrointestinal epithelial neoplasia.  Gut. 2000;  47 251-255
    CrossrefPubMedSearch in Google Scholar
  • 14 Nishi M, Omori Y, Miwa K. Japanese Research Society for Gastric Cancer. Japanese classification of gastric carcinoma. 1st English edn. Tokyo; Kanehara 1995
    Search in Google Scholar
  • 15 Ell C, May A, Gossner L. et al . Endoscopic mucosal resection of early cancer and high grade dysplasia in Barrett’s esophagus.  Gastroenterology. 2000;  118 670-677
    CrossrefPubMedSearch in Google Scholar
  • 16 Ell C, May A, Wurster H. The first reusable multiple band ligator for endoscopic hemostasis of variceal bleeding, nonvariceal bleeding and mucosal resection.  Endoscopy. 1999;  31 1-3
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Barr H, Shepherd N A, Dix A. et al . Eradication of high grade dysplasia in columnar-lined (Barrett’s) oesophagus by photodynamic therapy with endogenously generated protoporphyrin IX.  Lancet. 1996;  348 584-585
    CrossrefPubMedSearch in Google Scholar
  • 18 Gossner L, Stolte M, Sroka R. et al . Photodynamic ablation of high-grade dysplasia and early cancer in Barrett’s esophagus by means of 5-aminolevulinic acid.  Gastroenterology. 1998;  114 448-455
    PubMedSearch in Google Scholar
  • 19 Gossner L, May A, Sroka R. et al . Photodynamic destruction of high grade dysplasia and early carcinoma of the esophagus after oral administration of 5-aminolevulinic acid.  Cancer. 1999;  86 1921-1928
    CrossrefPubMedSearch in Google Scholar
  • 20 Byrne J P. Restoration of the normal squamous lining in Barrett’s esophagus by argon beam plasma coagulation.  Am J Gastroenterol. 1998;  93 1810-1815
    CrossrefPubMedSearch in Google Scholar
  • 21 van den Boogert J, van Hillegersberg R, Siersema P D. et al . Endoscopic ablation therapy for Barrett’s esophagus with high grade dysplasia: a review.  Am J Gastroenterol. 1999;  94 1153-1160
    PubMedSearch in Google Scholar
  • 22 Gossner L, May A, Stolte M. et al . KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett’s esophagus.  Gastrointest Endosc. 1999;  49 8-12
    CrossrefPubMedSearch in Google Scholar
  • 23 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
    CrossrefPubMedSearch in Google Scholar
  • 24 Cameron A J, Carpenter H A. Barrett’s esophagus, high-grade dysplasia, and early adenocarcinoma: a pathological study.  Am J Gastroenterol. 1997;  92 586-591
    PubMedSearch in Google Scholar
  • 25 Inoue H, Takeshita K, Hori H. et al . Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach and colon mucosal lesions.  Gastrointest Endosc. 1993;  39 58-62
    CrossrefPubMedSearch in Google Scholar
  • 26 Ackroyd R, Brown N J, Davis M F, Stephenson T J. et al . Photodynamic therapy for dysplastic Barrett’s esophagus: a prospective, double blind, randomised, placebo controlled trial.  Gut. 2000;  47 612-617
    CrossrefPubMedSearch in Google Scholar
  • 27 Heitmiller R F, Redmond M, Hamilton S R. Barrett’s esophagus with high grade dysplasia: an indication for prophylactic esophagectomy.  Ann Surg. 1996;  224 66-71
    CrossrefPubMedSearch in Google Scholar
  • 28 Hölscher A H, Bollschweiler E, Schneider P M, Siewert J R. Early adenocarcinoma in Barrett’s oesophagus.  Br J Surg. 1997;  84 1470-1473
    CrossrefPubMedSearch in Google Scholar
  • 29 Nigro J J, Hagen J A, DeMeester T R. et al . Occult esophageal adenocarcinoma: extent of disease and implications for effective therapy.  Ann Surg. 1999;  230 433-440
    CrossrefPubMedSearch in Google Scholar
  • 30 Stein H J, Feith M, Mueller J. et al . Limited resection for early adenocarcinoma in Barrett’s esophagus.  Ann Surg. 2000;  232 733-742
    CrossrefPubMedSearch in Google Scholar

C. Ell, M.D., Ph.D.

Department of Internal Medicine II · HSK Wiesbaden

Ludwig-Erhard-Straße 100 · 65199 Wiesbaden · Germany

Fax: + 49-611-432418

Email: Med2.hsk-wiesbaden@knuut.de