OUTCOME OF ADENOCARCINOMA ARISING IN BARRETTS-ESOPHAGUS IN ENDOSCOPICALLY SURVEYED AND NONSURVEYED PATIENTS

The value of endoscopic surveillance of Barrett's esophagus and the ap propriate management of high-grade dysplasia remain unclear. Seventeen patients who were referred from endoscopic surveillance programs for management of high-grade dysplasia or adenocarcinoma developing in Bar rett's esophagus were compared with 35 patients who had a newly recogn ized Barrett's adenocarcinoma, who had not been in a surveillance prog ram. The referral diagnosis in the surveyed group was adenocarcinoma i n six and high-grade dysplasia in 11. After repeat endoscopy with aggr essive biopsy, two additional patients with adenocarcinoma were identi fied. Of the nine patients who underwent esophagectomy for high-grade dysplasia, five had invasive adenocarcinoma in the esophagectomy speci men, which had been missed before the operation, despite the fact that the median number of biopsy specimens obtained per 2 cm of Barrett's mucosa was 7.8 (range 1.5 to 15.0). Overall, 13 patients in the survey ed group had adenocarcinoma, 12 staged early and one staged intermedia te by the WNM classification. Surveyed patients were operated on at an earlier stage than the nonsurveyed patients (10 early, 14 intermediat e, and 11 late stage tumors; chi(2) = 15.6, p < 0.01). Despite, the pr esence of adenocarcinoma in 13 of the 17 surveyed patients, their surv ival was significantly better than that of the nonsurveyed group (chi( 2) = 5.8, p < 0.05). Patients referred from surveillance programs for Barrett's esophagus have a better outcome and earlier stage tumors tha n nonsurveyed patients. Inasmuch as multiple biopsy procedures do not exclude the presence of adenocarcinoma, continued surveillance of high -grade dysplasia is dangerous and potentially destructive to surveilla nce efforts.