Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus
SUMMARY The management of high‐grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high‐grade dysplasi...
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| Veröffentlicht in: | Diseases of the esophagus 2012-05, Vol.25 (4), p.349-355 |
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| creator | Wang, K. K. Tian, J. M. Gorospe, E. Penfield, J. Prasad, G. Goddard, T. WongKeeSong, M. Buttar, N. S. Lutzke, L. Krishnadath, S. |
| description | SUMMARY
The management of high‐grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high‐grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio‐frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett's esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long‐term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients. |
| doi_str_mv | 10.1111/j.1442-2050.2012.01342.x |
| format | Article |
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The management of high‐grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high‐grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio‐frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett's esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long‐term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients.</description><identifier>ISSN: 1120-8694</identifier><identifier>EISSN: 1442-2050</identifier><identifier>DOI: 10.1111/j.1442-2050.2012.01342.x</identifier><identifier>PMID: 22409514</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>ablation ; Barrett Esophagus - genetics ; Barrett Esophagus - metabolism ; Barrett Esophagus - pathology ; Barrett Esophagus - therapy ; Barrett's esophagus ; Biomarkers - metabolism ; Catheter Ablation ; esophageal cancer ; Esophagoscopy ; Gene Expression Profiling ; Humans ; mucosal resection ; Mucous Membrane - surgery ; Photochemotherapy ; Precancerous Conditions - genetics ; Precancerous Conditions - metabolism ; Precancerous Conditions - pathology ; Precancerous Conditions - therapy</subject><ispartof>Diseases of the esophagus, 2012-05, Vol.25 (4), p.349-355</ispartof><rights>2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus</rights><rights>2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4642-84f3f70dbbf38998815ba01091a18e111c4b02dafa6c426f4a6e759f9f7521933</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1442-2050.2012.01342.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1442-2050.2012.01342.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22409514$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, K. K.</creatorcontrib><creatorcontrib>Tian, J. M.</creatorcontrib><creatorcontrib>Gorospe, E.</creatorcontrib><creatorcontrib>Penfield, J.</creatorcontrib><creatorcontrib>Prasad, G.</creatorcontrib><creatorcontrib>Goddard, T.</creatorcontrib><creatorcontrib>WongKeeSong, M.</creatorcontrib><creatorcontrib>Buttar, N. S.</creatorcontrib><creatorcontrib>Lutzke, L.</creatorcontrib><creatorcontrib>Krishnadath, S.</creatorcontrib><title>Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus</title><title>Diseases of the esophagus</title><addtitle>Dis Esophagus</addtitle><description>SUMMARY
The management of high‐grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high‐grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio‐frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett's esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long‐term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients.</description><subject>ablation</subject><subject>Barrett Esophagus - genetics</subject><subject>Barrett Esophagus - metabolism</subject><subject>Barrett Esophagus - pathology</subject><subject>Barrett Esophagus - therapy</subject><subject>Barrett's esophagus</subject><subject>Biomarkers - metabolism</subject><subject>Catheter Ablation</subject><subject>esophageal cancer</subject><subject>Esophagoscopy</subject><subject>Gene Expression Profiling</subject><subject>Humans</subject><subject>mucosal resection</subject><subject>Mucous Membrane - surgery</subject><subject>Photochemotherapy</subject><subject>Precancerous Conditions - genetics</subject><subject>Precancerous Conditions - metabolism</subject><subject>Precancerous Conditions - pathology</subject><subject>Precancerous Conditions - therapy</subject><issn>1120-8694</issn><issn>1442-2050</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkVtv1DAQhS0EoqXwF5Df4CXBYztO8oIEbdki9QKoiMfRJLGzXnIjztLdf09CywLzMiMd65vjOYxxEDHM9WYTg9YykiIRsRQgYwFKy3j3iB0fhMfzDFJEmcn1EXsWwkYISJXJnrIjKbXIE9DH7NOVrXxJDaeu4rar-lD2gy95Sx3VtrXdxHvH175eR_VIleXVPgwNBU_cd_w9jaOdpleB29APa6q34Tl74qgJ9sVDP2FfP5zfnl5Elzerj6fvLqNSm9lhpp1yqaiKwqksz7MMkoIEiBwIMjv_sdSFkBU5MqWWxmkyNk1yl7s0kZArdcLe3nOHbdHaqpydjtTgMPqWxj325PF_pfNrrPufqOdTgTQz4PUDYOx_bG2YsPWhtE1Dne23AUGABtBCyfnpy393HZb8OeNfM3e-sfuDDgKXuHCDSyq4pIJLXPg7Ltzh2c3t-TLOgOge4MNkdwcAjd_RpCpN8Nv1Co2-_pyuzr7glfoFs8eYEg</recordid><startdate>201205</startdate><enddate>201205</enddate><creator>Wang, K. K.</creator><creator>Tian, J. M.</creator><creator>Gorospe, E.</creator><creator>Penfield, J.</creator><creator>Prasad, G.</creator><creator>Goddard, T.</creator><creator>WongKeeSong, M.</creator><creator>Buttar, N. S.</creator><creator>Lutzke, L.</creator><creator>Krishnadath, S.</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201205</creationdate><title>Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus</title><author>Wang, K. K. ; Tian, J. M. ; Gorospe, E. ; Penfield, J. ; Prasad, G. ; Goddard, T. ; WongKeeSong, M. ; Buttar, N. S. ; Lutzke, L. ; Krishnadath, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4642-84f3f70dbbf38998815ba01091a18e111c4b02dafa6c426f4a6e759f9f7521933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>ablation</topic><topic>Barrett Esophagus - genetics</topic><topic>Barrett Esophagus - metabolism</topic><topic>Barrett Esophagus - pathology</topic><topic>Barrett Esophagus - therapy</topic><topic>Barrett's esophagus</topic><topic>Biomarkers - metabolism</topic><topic>Catheter Ablation</topic><topic>esophageal cancer</topic><topic>Esophagoscopy</topic><topic>Gene Expression Profiling</topic><topic>Humans</topic><topic>mucosal resection</topic><topic>Mucous Membrane - surgery</topic><topic>Photochemotherapy</topic><topic>Precancerous Conditions - genetics</topic><topic>Precancerous Conditions - metabolism</topic><topic>Precancerous Conditions - pathology</topic><topic>Precancerous Conditions - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, K. K.</creatorcontrib><creatorcontrib>Tian, J. M.</creatorcontrib><creatorcontrib>Gorospe, E.</creatorcontrib><creatorcontrib>Penfield, J.</creatorcontrib><creatorcontrib>Prasad, G.</creatorcontrib><creatorcontrib>Goddard, T.</creatorcontrib><creatorcontrib>WongKeeSong, M.</creatorcontrib><creatorcontrib>Buttar, N. S.</creatorcontrib><creatorcontrib>Lutzke, L.</creatorcontrib><creatorcontrib>Krishnadath, S.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diseases of the esophagus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, K. K.</au><au>Tian, J. M.</au><au>Gorospe, E.</au><au>Penfield, J.</au><au>Prasad, G.</au><au>Goddard, T.</au><au>WongKeeSong, M.</au><au>Buttar, N. S.</au><au>Lutzke, L.</au><au>Krishnadath, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus</atitle><jtitle>Diseases of the esophagus</jtitle><addtitle>Dis Esophagus</addtitle><date>2012-05</date><risdate>2012</risdate><volume>25</volume><issue>4</issue><spage>349</spage><epage>355</epage><pages>349-355</pages><issn>1120-8694</issn><eissn>1442-2050</eissn><abstract>SUMMARY
The management of high‐grade dysplasia in Barrett's esophagus has clearly changed over recent years. The risk of cancer development is still substantial, with about one in three patients developing cancer, but a number of patients do not develop cancer. The nature of high‐grade dysplasia has also been genetically elucidated with more evidence of chromosomal instability being present at this stage than previously thought. Therapy of the condition has evolved more toward endoscopic therapy, given the good results of radio‐frequency ablation and photodynamic therapy in eliminating dysplasia and decreasing cancer development in randomized controlled trial. The best candidates for treatment include compliant patients that have relatively short segments of Barrett's esophagus, an anatomically straight segment, lack of nodularity, and an intact p16. However, even with excellent long‐term results similar to surgical resection, the risk of recurrence is present in over 14% of patients, which indicates that there will be a need to continue surveillance endoscopy in these patients.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>22409514</pmid><doi>10.1111/j.1442-2050.2012.01342.x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Wiley Online Library All Journals |
| subjects | ablation Barrett Esophagus - genetics Barrett Esophagus - metabolism Barrett Esophagus - pathology Barrett Esophagus - therapy Barrett's esophagus Biomarkers - metabolism Catheter Ablation esophageal cancer Esophagoscopy Gene Expression Profiling Humans mucosal resection Mucous Membrane - surgery Photochemotherapy Precancerous Conditions - genetics Precancerous Conditions - metabolism Precancerous Conditions - pathology Precancerous Conditions - therapy |
| title | Medical and endoscopic management of high-grade dysplasia in Barrett's esophagus |
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