Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett's esophagus with high-grade dysplasia☆,☆☆
Section snippets
Patients and Methods
We studied 2 groups of patients with Barrett's esophagus who were undergoing extensive evaluation for high-grade dysplasia prior to undergoing esophagectomy. The patients in the first group, identified between 1986 and 1991 and evaluated with a standard endoscopic biopsy forceps protocol, have been reported on elsewhere.3 The patients in the second group, identified between 1993 and 1997, were evaluated by using jumbo biopsy forceps and a more rigorous biopsy protocol (see below). All
RESULTS
Demographics of the study population are shown in Table 1.
Parameter Standard biopsy Jumbo biopsy Empty Cell protocol protocol Number of patients 16 12 Male/female 16/0 12/0 Mean age (range) 63 yr (36-79 yr) 57 yr (50-65 yr) Mean length of Barrett's 7.5 cm (2-13 cm) 8.9 cm (5-15 cm) segment (range)
DISCUSSION
The best approach to the patient with Barrett's esophagus and high-grade dysplasia is uncertain. Esophagectomy is recommended by many authorities to eliminate the risk of carcinoma or to detect and treat cancer at an early curable stage. Others argue that the risk of esophagectomy is too high and that the natural history of high-grade dysplasia is too variable to justify such invasive surgery without a preoperative diagnosis of at least intramucosal carcinoma. Thus, the major controversies
Acknowledgements
We thank Michael Vaezi, MD, for his helpful comments and suggestions in reviewing the manuscript, and Kirk Easley, for his statistical assistance.
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Cited by (0)
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Reprint requests: Gary W. Falk, MD, Department of Gastroenterology, Desk S-40, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
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