SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Jean-Michel ROUILLON
Coup de coeur :
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):987-992  
  doi: 10.1053/j.gastro.2016.12.005  
 
  Low Risk of High-Grade Dysplasia or Esophageal Adenocarcinoma Among Patients With Barrett's Esophagus Less Than 1 cm (Irregular Z Line) Within 5 Years of Index Endoscopy.  
 
  Thota PN, Vennalaganti P, Vennelaganti S, Young P, Gaddam S, Gupta N, Lieberman D, Sampliner R, Falk GW, Mathur S, Kennedy K, Cash BD, Moawad F, Bansal A, Spaander MC, Bruno MJ, Vargo J, Sharma P  
  https://www.ncbi.nlm.nih.gov/pubmed/27988383  
 
 

Abstract

BACKGROUND & AIMS:

Many patients with a < 1 cm segment of columnar metaplasia in the distal esophagus, also called an irregular Z line, are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia.

METHODS:

We performed a prospective, multicenter cohort study of patients who underwent endoscopic examination for BE at tertiary care referral centers in the United States and Europe. We analyzed data from 1791 patients (mean age, 56 ± 17 years) found to have non-dysplastic BE at the index endoscopy and after 1 year or more of follow-up. Patients were followed for a median of 5.9 years (interquartile range, 3.1-8.3 years). We calculated rates of progression to HGD or EAC between groups of patients with irregular Z line (n = 167) and those with BE of ≥ 1 cm (n = 1624).

RESULTS:

A higher proportion of patients in the irregular Z-line group were female (26.3%) than in the BE group (14.8% female BE) (P <.001). A lower proportion of patients in the irregular Z-line group were smokers (33.5%) than in the BE group (52.6% smokers). None of the patients with irregular Z line developed HGD or EAC during a median follow-up period of 4.8 years (interquartile range, 3.2-8.3 years). All 71 incident cases of HGD or EAC developed in patients with BE of ≥1 cm in length. On multivariate analysis, patients with irregular Z line and patients with BE of ≥ 1 cm did not differ significantly in age, race, or duration of follow-up.

CONCLUSIONS:

In a prospective, multicenter cohort study, we found that patients with irregular Z line do not develop HGD or esophageal cancer within 5 years after index endoscopy.

 
Question posée
 
Quel est le risque de dysplasie de haut grade ou d'adénocarcinome dans les endobrachyoesophages courts (moins de 1 cm)?
 
Question posée
 
Dans cette étude prospective multicentrique Européenne et Américaine portant sur 1791 patients porteurs de Barrett et suivis sur 5 ans aucune dysplasie de haut grade ou d'adénocarcinome n'a été constatée chez les patients porteurs de Barrett court, comparativement aux EBO de plus de 1 cm.
 
Commentaires

La surveillance des Barrett courts doit probablement être allégée par rapport aux EBO plus étendus, avec une surveillance suggérée tous les 5 ans à confirmer par d'autres études.

 
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