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Thématique :
- Endoscopie/Imagerie
- Œsophage/Estomac
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Originalité :
Intermédiaire
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| Doit faire évoluer notre pratique : |
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Dans certains cas
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Nom du veilleur :
Docteur Florian ROSTAIN
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Endoscopy
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2015/08
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2015 Aug;47(8):669-74
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doi: 10.1055/s-0034-1391966
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Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study
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Sinh P, Anaparthy R, Young PE, Gaddam S, Thota P, Balasubramanian G, Singh M, Higbee AD, Wani S, Gupta N, Rastogi A, Mathur SC, Bansal A, Horwhat JD, Cash BD, Falk GW, Lieberman DA, Vargo JJ, Sampliner RE, Sharma P
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http://www.ncbi.nlm.nih.gov/pubmed/25910065
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BACKGROUND AND STUDY AIM:
Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy.
PATIENTS AND METHODS:
Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated.
RESULTS:
Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar.
CONCLUSIONS:
Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.
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Quel est le taux d’évolution d’un endobrachy-oesophage (EBO) indéfini pour la dysplasie (IND) vers la dysplasie de haut grade et l’adénocarcinome ? Y-a-t-il un potentiel évolutif différent de la dysplasie de bas grade (DGB) ?
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Études rétrospectives dans 5 centres Américains sur 2264 patients dont 83 classés en IND.
Dans le groupe IND, l’incidence annuelle de l’adénocarcinome et de la dysplasie de haut grade était de 0,65% et 0,87% respectivement ; dans le groupe BGD les taux sont de 0,21% et 0,64% respectivement ; soit similaires.
67 des 83 patients du groupe IND (80%), et 61 des 79 patients du groupe BGD (77.2%) ont eu un statut histologique qui a régressé en non dysplasique au cours du suivi.
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La surveillance des endobrachy-oesophages indéfinis pour la dysplasie pourrait être calquée à celle des EBO en dysplasie de bas grade. Le profil évolutif est faible mais nécessite le maintien de la surveillance.
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