Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(09): E1085-E1092
DOI: 10.1055/a-0640-3030
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Impact of the development of an endoscopic eradication program for Barrett’s esophagus with high grade dysplasia or early adenocarcinoma on the frequency of surgery[*]

Prianka Chilukuri   **
1   Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
,
Mark A. Gromski   **
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Cynthia S. Johnson
3   Department of Biostatistics, Indiana University, Indianapolis, IN, USA
,
Duy Khanh P. Ceppa
4   Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
,
Kenneth A. Kesler
4   Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
,
Thomas J. Birdas
4   Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
,
Karen M. Rieger
4   Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
,
Hala Fatima
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
William R. Kessler
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Douglas K. Rex
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
Mohammad Al-Haddad
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
,
John M. DeWitt
2   Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
› Author Affiliations
Further Information

Publication History

submitted 08 November 2017

accepted after revision 12 March 2018

Publication Date:
11 September 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background and aims The impact of the advent of an institutional endoscopic eradication therapy (EET) program on surgical practice for Barrett’s esophagus (BE)-associated high grade dysplasia (HGD) or suspected T1a esophageal adenocarcinoma (EAC) is unknown. The aims of this study are to evaluate the different endoscopic modalities used during development of our EET program and factors associated with the use of EET or surgery for these patients after its development.

Methods Patients who underwent primary endoscopic or surgical treatment for BE-HGD or early EAC at our hospital between January 1992 and December 2014 were retrospectively identified. They were categorized by their initial modality of treatment during the first year, and the impact over time for choice of therapy was assessed by multivariable logistic regression.

Results We identified 386 patients and 80 patients who underwent EET and surgery, respectively. EET included single modality therapy in 254 (66 %) patients and multimodal therapy in 132 (34 %) patients. Multivariable logistic regression showed that, for each subsequent study year, EET was more likely to be performed in patients who were older (P = 0.0009), with shorter BE lengths (P < 0.0001), and with a pretreatment diagnosis of HGD (P = 0.0054) compared to surgical patients. The diagnosis of EAC did not increase the utilization of EET compared to surgery as time progressed (P = 0.8165).

Conclusion The introduction of an EET program at our hospital increased the odds of utilizing EET versus surgery over time for initial treatment of patients who were older, had shorter BE lengths or the diagnosis of BE-HGD, but not in patients with EAC.

     * Abstract and poster presentation: “Primary Endoscopic Therapy vs. Surgical Management of Barrett’s Esophagus with High Grade Dysplasia or Early Adenocarcinoma: Experience of a Tertiary Referral Center 1992 – 2014.” DDW 2016, San Diego, CA, USA.


** Co-first authors.


 

  • References

  • 1 Spechler SJ. Clinical practice. Barrett’s esophagus. NEJM 2002; 346: 836-842 [doi:10.1056/NEJMcp012118]
    CrossrefPubMedSearch in Google Scholar
  • 2 Spechler SJ, Souza RF. Barrett’s esophagus. NEJM 2014; 371: 836-845 [doi:10.1056/NEJMra1314704]
    CrossrefPubMedSearch in Google Scholar
  • 3 Rastogi A, Puli S, El-Serag HB. et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc 2008; 67: 394-398 [doi:10.1016/j.gie.2007.07.019]
    CrossrefPubMedSearch in Google Scholar
  • 4 Begg CB, Cramer LD, Hoskins WJ. et al. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 1998; 280: 1747-1751
    CrossrefPubMedSearch in Google Scholar
  • 5 Swisher SG, Deford L, Merriman KW. et al. Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 2000; 119: 1126-1132 [doi:10.1067/mtc.2000.105644]
    CrossrefPubMedSearch in Google Scholar
  • 6 Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005; 97: 142-146 [doi:10.1093/jnci/dji024]
    CrossrefPubMedSearch in Google Scholar
  • 7 Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol 2012; 23: 3155-3162 [doi:10.1093/annonc/mds181]
    CrossrefPubMedSearch in Google Scholar
  • 8 Brown LM, Devesa SS, Chow WH. Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. J Natl Cancer Inst 2008; 100: 1184-1187 [doi:10.1093/jnci/djn211]
    CrossrefPubMedSearch in Google Scholar
  • 9 Eloubeidi MA, Mason AC, Desmond RA. et al. Temporal trends (1973-1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope?. Am J Gastroenterol 2003; 98: 1627-1633 [doi:10.1111/j.1572-0241.2003.07454.x]
    CrossrefPubMedSearch in Google Scholar
  • 10 Conio M, Cameron AJ, Romero Y. et al. Secular trends in the epidemiology and outcome of Barrett’s oesophagus in Olmsted County, Minnesota. Gut 2001; 48: 304-309
    CrossrefPubMedSearch in Google Scholar
  • 11 Pech O, Bollschweiler E, Manner H. et al. Comparison between endoscopic and surgical resection of mucosal esophageal adenocarcinoma in Barrett’s esophagus at two high-volume centers. Ann Surg 2011; 254: 67-72 [doi:10.1097/SLA.0b013e31821d4bf6]
    CrossrefPubMedSearch in Google Scholar
  • 12 Prasad GA, Wang KK, Buttar NS. et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett’s esophagus. Gastroenterology 2007; 132: 1226-1233 [doi:10.1053/j.gastro.2007.02.017]
    CrossrefPubMedSearch in Google Scholar
  • 13 Prasad GA, Wu TT, Wigle DA. et al. Endoscopic and surgical treatment of mucosal (T1a) esophageal adenocarcinoma in Barrett’s esophagus. Gastroenterology 2009; 137: 815-823 [doi:10.1053/j.gastro.2009.05.059]
    CrossrefPubMedSearch in Google Scholar
  • 14 Schmidt HM, Mohiuddin K, Bodnar AM. et al. Multidisciplinary treatment of T1a adenocarcinoma in Barrett’s esophagus: contemporary comparison of endoscopic and surgical treatment in physiologically fit patients. Surg Endosc 2016; 30: 3391-3401 [doi:10.1007/s00464-015-4621-z]
    CrossrefPubMedSearch in Google Scholar
  • 15 Wani S, Drahos J, Cook MB. et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc 2014; 79: 224-232 e221 [doi:10.1016/j.gie.2013.08.002]
    CrossrefPubMedSearch in Google Scholar
  • 16 Wu J, Pan YM, Wang TT. et al. Endotherapy versus surgery for early neoplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc 2014; 79: 233-241 e232 [doi:10.1016/j.gie.2013.08.005]
    CrossrefPubMedSearch in Google Scholar
  • 17 Barnes JA, Willingham FF. Endoscopic management of early esophageal cancer. J Clin Gastroenterol 2015; 49: 638-646 [doi:10.1097/MCG.0000000000000353]
    CrossrefPubMedSearch in Google Scholar
  • 18 Pouw RE, Wirths K, Eisendrath P. et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol 2010; 8: 23-29 [doi:10.1016/j.cgh.2009.07.003]
    CrossrefPubMedSearch in Google Scholar
  • 19 Bennett C, Vakil N, Bergman J. et al. Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 2012; 143: 336-346 [doi:10.1053/j.gastro.2012.04.032]
    CrossrefPubMedSearch in Google Scholar
  • 20 NCCN. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Esophageal and Esophagogastric Junction Cancers. Version 2.2012. www.NCCN.org
    PubMed
  • 21 Ngamruengphong S, Wolfsen HC, Wallace MB. Survival of patients with superficial esophageal adenocarcinoma after endoscopic treatment vs surgery. Clin Gastroenterol Hepatol 2013; 11: 1424-1429 e1422 , quiz e1481 [doi:10.1016/j.cgh.2013.05.025]
    CrossrefPubMedSearch in Google Scholar
  • 22 Zehetner J, DeMeester SR, Hagen JA. et al. Endoscopic resection and ablation versus esophagectomy for high-grade dysplasia and intramucosal adenocarcinoma. J Thorac Cardiovasc Surg 2011; 141: 39-47 [doi:10.1016/j.jtcvs.2010.08.058]
    CrossrefPubMedSearch in Google Scholar
  • 23 Schembre DB, Huang JL, Lin OS. et al. Treatment of Barrett’s esophagus with early neoplasia: a comparison of endoscopic therapy and esophagectomy. Gastrointest Endosc 2008; 67: 595-601 [doi:10.1016/j.gie.2007.08.042]
    CrossrefPubMedSearch in Google Scholar
  • 24 Reed MF, Tolis Jr. G, Edil BH. et al. Surgical treatment of esophageal high-grade dysplasia. Ann Thorac Surg 2005; 79: 1110-1115 [doi:10.1016/j.athoracsur.2004.09.006]
    CrossrefPubMedSearch in Google Scholar
  • 25 Pacifico RJ, Wang KK, Wongkeesong LM. et al. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett’s esophagus. Clin Gastroenterol Hepatol 2003; 1: 252-257
    CrossrefPubMedSearch in Google Scholar
  • 26 Evans JA, Early DS, Fukami N. et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 2012; 76: 1087-1094 [doi:10.1016/j.gie.2012.08.004]
    CrossrefPubMedSearch in Google Scholar
  • 27 Jacobson BC, Hirota W, Baron TH. et al. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2003; 57: 817-822
    CrossrefPubMedSearch in Google Scholar
  • 28 Evans JA, Early DS, Chandraskhara V. et al. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest Endosc 2013; 77: 328-334 [doi:10.1016/j.gie.2012.10.001]
    CrossrefPubMedSearch in Google Scholar
  • 29 O’Farrell NJ, Reynolds JV, Ravi N. et al. Evolving changes in the management of early oesophageal adenocarcinoma in a tertiary centre. Ir J Med Sci 2013; 182: 363-369 [doi:10.1007/s11845-012-0890-x]
    CrossrefPubMedSearch in Google Scholar