Barrett’s Esophagus: Prevalence and Efficacy of Endoscopic Mucosectomy
Emad F. Hamed1, Waseem M. Seleem1, Ehab F. Mostafa1, Noha E. Shaheen2 and Rafaat A. Hegazy3
1Internal medicine, 2Tropical medicine and 3Pathology Departments, Zagazig University, Egypt
Abstract: Background: Barrett's esophagus (BE) is a premalignant condition in which the normal squamous epithelium of the esophagus is replaced by intestinal metaplasia of variable degrees. It represents the most serious consequence of gastroesophageal reflux disease (GERD), as it may progress to adenocarcinoma. Aim of the Work: The aim of this study is to estimate the prevalence of BE as well as the variable degrees of metaplasia in patients with GERD and to study the efficacy of endoscopic mucosectomy in treatment of BE with high grade dysplasia (HGD) or intramucosal cancer (IMC).Patients and Methods: We studied 1268 patients presented to the outpatient clinic and endoscopy unit in Zagazig University hospital complaining of symptoms suggestive of GERD. They were subjected to thorough history taking, full clinical examination, routine laboratory investigations including complete blood count, liver and renal function tests, random blood glucose, coagulation profile in addition to abdominal ultrasonography, electrocardiography, upper gastrointestinal endoscopy for diagnosis of GERD and grading of its severity with biopsy taking and histopathological examination for patients who had BE. All patients with BE had a CT scan of their chest and abdomen. Patients who had BE with HGD or IMC were subjected to endoscopic mucosal resection (EMR). All patients with BE were followed for a median of 20 months with repeated upper endoscopy. Results : Out of 1268 patients presented to the outpatient clinic complaining of symptoms suggestive of GERD, 874 had endoscopic finding of various grades of reflux esophagitis and 52 patients had BE. Histopathological examination revealed that 35 patients had HGD, 12 patients had low grade dysplasia (LGD) and 5 patients had IMC. BE was more prevalent among the elderly males, obese patients and smokers. Those with HGD or carcinoma in situ (40 patients) were subjected to EMR and we found that EMR altered the histological grading of BE in 25 % of patients while 12.5 % were downgraded to LGD. EMR was associated with few complications the most significant of which was bleeding (10% of patients). One patient (2.5%) developed esophageal stenosis which was successfully managed by a single bougienage dilatation. Patients with LGD (12 patients) in addition to the 40 patients who had EMR were subjected to follow-up for a median of 20 months. One patient (2.5%) had a metachronous lesion detected after 25 months that was successfully treated with another EMR and histologically was still HGD. LGD patients had no change in grading during the follow up period.Conclusions: BE is a substantial medical problem in patients with GERD. EMR is a feasible, effective and low risk procedure that can be used to treat HGD and IMC which may complicate BE. Patients should be evaluated carefully prior to EMR and those with superficial lesions are the ideal candidates for EMR. However, it is strongly recommended to follow those patients by upper gastrointestinal endoscopy at regular intervals to rule out any recurrence.
[Emad F. Hamed, Waseem M. Seleem, Ehab F. Mostafa, Noha E. Shaheen, and Rafaat A. Hegazy.Barrett’s Esophagus: Prevalence and Efficacy of Endoscopic Mucosectomy. J Am Sci 2013;9(3):253-260]. (ISSN: 1545-1003). http://www.americanscience.org. 35
Key words: GERD, Barrett’s esophagus, Endoscopic mucosectomy. Full Text 35