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- W2005471812 abstract "Background: Endoscopic therapies for Barrett's esophagus (BE) related high-grade dysplasia (HGD) and intra-mucosal carcinoma (IMC) may spare patients esophagectomy. Currently, little data exists comparing the efficacy, risks and costs of endoscopic and surgical approaches to this disease. Methods: Prospectively collected data on all patients with Barrett's HGD or IMC treated either endoscopically (photodynamic therapy (PDT), endoscopic mucosal resection (EMR) or thermal ablation) or surgically (esophagectomy) with curative intent at one institution from 5/1998 until 11/2005 was compared. Patients found to have invasive cancer during initial staging, and those who had less than 6 months follow-up were excluded. Total hospital and out-patient charges were also compared. Groups were compared by 2-tailed student's t-test. Results: 64 patients who underwent endoscopic therapy (2 argon plasma coagulation alone, 18 EMR, 21 PDT and 23 EMR + PDT) and 32 patients who underwent esophagectomy (4 trans-hiatal, 10 Ivor-Lewis, 18 left thoraco-abdominal) met the inclusion criteria. Average follow-up time was 20 months for endotherapy and 12 months for surgical patients. The median age was 70 for endotherapy and 64 for surgery (p < 0.01). Average ASA classifications were 2.6 and 2.5 respectively (p = ns). Females accounted for 21% of the endotherapy and 6% of the surgical patients. 30-day mortality occurred in 1 patient in the endotherapy group (2%) and none of surgical group (p = ns). No death from esophageal cancer occurred in either group. Invasive cancer developed in 6% of endotherapy patients. No distant cancers developed in the surgical cohort (p < 0.05), despite identifying previously unrecognized invasive cancer in 8 (25%) of the resected esophagi. 1 patient who had EMR for IMC had no identifiable dysplasia or BE at surgery. Major complications, (death, bleeding, pain requiring hospitalization) and minor complications (photosensitivity, stricture) occurred in 9% and 29% of endotherapy patients, respectively. 31% of surgical patients experienced major complications (anastamotic leak, pneumonia, PE) and 65% minor complications (strictures, wound infections, dysrythmias) (p < 0.01). Median cost to date was $40,079 for endotherapy and $66,060 for esophaectomy (p < 0.01). Conclusions: Both endotherapy and esophagectomy can effectively treat HGD and IMC associated with BE. Endotherapy is associated with a higher risk of tumor progression, although this is uncommon. Esophagectomy is associated with higher initial costs and more frequent complications but is usually curative for HGD and IMC and may effectively treat previously unidentified early invasive cancer." @default.
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- W2005471812 date "2006-04-01" @default.
- W2005471812 modified "2023-10-18" @default.
- W2005471812 title "Endotherapy Versus Esophagectomy for Barrett's Esophagus with High-Grade Dysplasia Or Intra-Mucosal Carcinoma: A Review of Outcomes" @default.
- W2005471812 doi "https://doi.org/10.1016/j.gie.2006.03.035" @default.
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