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Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study.

ABSTRACT: OBJECTIVES:To review the benefit of an endoscopic surveillance programme for patients with Barrett's oesophagus. DESIGN:Observational study. SETTING:University teaching hospital. PARTICIPANTS:409 patients in whom Barrett's oesophagus was identified during 1984-94; 143 were entered into the annual surveillance programme. MAIN OUTCOME MEASURES:Development of dysplasia and cancer and mortality. RESULTS:The average period of surveillance was 4.4 years; 55 patients were reassessed in 1994 but only eight remained in the programme in 1999, withdrawal being due to death (not from carcinoma of the oesophagus), illness, or frailty. Five of the patients who entered surveillance developed carcinoma of the oesophagus. Only one cancer was identified as a result of a surveillance endoscopy, the others being detected during endoscopy to investigate altered symptoms. Of the 266 patients who were not suitable for surveillance, one died from oesophageal cancer and 103 from other causes. Surveillance has resulted in 745 endoscopies and about 3000 biopsy specimens. CONCLUSION:The current surveillance strategy has limited value, and it may be appropriate to restrict surveillance to patients with additional risk factors such as stricture, ulcer, or long segment (>80 mm) Barrett's oesophagus.

SUBMITTER: Macdonald CE

PROVIDER: S-EPMC27527 | biostudies-literature | 2000 Nov

REPOSITORIES: biostudies-literature

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Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study.

Macdonald C E CE Wicks A C AC Playford R J RJ

BMJ (Clinical research ed.) 20001101 7271

<h4>Objectives</h4>To review the benefit of an endoscopic surveillance programme for patients with Barrett's oesophagus.<h4>Design</h4>Observational study.<h4>Setting</h4>University teaching hospital.<h4>Participants</h4>409 patients in whom Barrett's oesophagus was identified during 1984-94; 143 were entered into the annual surveillance programme.<h4>Main outcome measures</h4>Development of dysplasia and cancer and mortality.<h4>Results</h4>The average period of surveillance was 4.4 years; 55 p ...[more]

PMID: 11082084

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Project description:Barrett's oesophagus (BE) is the precursor lesion to adenocarcinoma of the oesophagus. Understanding of the molecular alterations in this multistage process may contribute to improved diagnosis and treatment. Secreted protein acidic and rich in cysteine (SPARC) is a matricellular protein that modulates cell adhesion and growth. Alterations in SPARC expression have been observed in a variety of solid tumours. The aim of this study was to assess the prevalence and timing of SPARC mRNA expression in Barrett's multistage disease and to investigate the impact of SPARC alterations on the development and progression of this disease. SPARC mRNA expression was measured using a quantitative real-time RT-PCR method in 108 specimens from 19 patients with BE without carcinoma, 20 patients with Barrett's-associated adenocarcinoma (EA), and a control group (CG) of 10 patients without evidence of gastro-oesophageal reflux disease. The median SPARC mRNA expression was significantly upregulated in BE tissues compared to paired normal oesophagus (NE) tissues for the BE group (P=0.004) and for the EA group (P<0.001). The SPARC mRNA expression was significantly higher in adenocarcinoma of the oesophagus compared to matching NE tissue and compared to Barrett's tissues in the EA group (P<0.001). Furthermore, SPARC expression values were significantly different between metaplastic and dysplastic Barrett's tissues (P=0.014). In histologically normal squamous oesophagus tissues obtained from carcinoma patients (EA group), the SPARC mRNA expression was significantly higher compared to NE mucosa from the BE group and the CG group (P=0.03). These findings suggest that the upregulation of SPARC mRNA expression is an early event in the development and progression of BE and EA, and that high SPARC expression may be a clinically useful biomarker for the detection of occult adenocarcinoma, and that a widespread 'field effect' is present in the NE of patients with oesophageal adenocarcinoma.

Dataset Information

Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study.

Publications

Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study.

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