SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2016/04  
 
  2016 Apr;65(4):548-54  
  doi: 10.1136/gutjnl-2014-308802  
 
  Impact of surveillance for Barrett's oesophagus on tumour stage and survival of patients with neoplastic progression  
 
  Kastelein F, van Olphen SH, Steyerberg EW, Spaander MC, Bruno MJ; ProBar-study group.  
  http://www.ncbi.nlm.nih.gov/pubmed/25903690  
 
 

Objective Endoscopic surveillance for Barrett's oesophagus (BO) is under discussion given the overall low incidence of neoplastic progression and lack of evidence that it prevents advanced oesophageal adenocarcinoma (OAC). The aim of this study was to evaluate the impact of endoscopic BO surveillance on tumour stage and survival of patients with neoplastic progression.Design 783 patients with BO of at least 2 cm were included in a multicentre prospective cohort and followed during surveillance according to the American College of Gastroenterology guidelines. Cases of high-grade dysplasia and OAC were identified during follow-up. OAC staging was performed according to the 7th UICC-AJCC classification. Survival data were collected and crosschecked using death and municipal registries. Data from patients with OAC in the general population were obtained from the Dutch cancer registry. We compared survival of patients with BO with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population.

Design 783 patients with BO of at least 2 cm were included in a multicentre prospective cohort and followed during surveillance according to the American College of Gastroenterology guidelines. Cases of high-grade dysplasia and OAC were identified during follow-up. OAC staging was performed according to the 7th UICC-AJCC classification. Survival data were collected and crosschecked using death and municipal registries. Data from patients with OAC in the general population were obtained from the Dutch cancer registry. We compared survival of patients with BO with neoplastic progression during surveillance with those of patients without neoplastic progression and patients with OAC in the general population.

Results 53 patients with BO developed high-grade dysplasia or OAC during surveillance. Thirty-five (66%) were classified as stage 0, 14 (26%) as stage 1 and 4 (8%) as stage 2. OAC was diagnosed at an earlier stage during BO surveillance than in the general population (p<0.001). Survival of patients with BO with neoplastic progression was not significantly worse than those of patients without neoplastic progression and similar to survival of patients with stage 0 or stage 1 OAC in the general population.

Conclusions OAC is detected at an earlier stage during BO surveillance than in the general population with good survival rates.

 
Question posée
 
La surveillance des endobrachyoesophage est-elle réellement efficace ?
 
Question posée
 
Cette étude menée prospectivement sur une cohorte de 783 patients suggère que la surveillance endoscopique permet de détecter des cancers plus précoces (2/3 sont classés stade 0) que ceux qui surviennent dans la population générale.
 
Commentaires

Cette tendance à surveiller et à détecter plus précocement des zones dysplasiques ou carcinomateuses devrait encore s’accroitre dans les années à venir compte-tenu des progrès de l’imagerie endoscopique et des possibilités de traitement mini-invasif.

 
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