Barrett’s Esopha
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
