Endoscopic therapies for early neoplasia in Barrett's esophagus may be a viable alternative to esophagectomy.
Dr Drew Schembre and colleagues from Washington, USA compared endoscopic therapy with esophagectomy.
The team undertook a retrospective review from a single institution,at a medium-sized tertiary referral center.
|Major complications occurred in 8% of endotherapy patients|
The team evaluated all patients with Barrett's esophagus and dysplasia or intramucosal carcinoma.
The patients were treated by photodynamic therapy, EMR, argon plasma coagulation or esophagectomy with curative intent from 1998 until 2005.
The research team compared survival, progression to cancer, eradication of dysplasia and Barrett's esophagus, major and minor complications, and costs.
The researchers reported that 62 patients underwent endoscopic therapy.
Of these, 2 received argon plasma coagulation alone, 18 EMR plus argon plasma coagulation, and 20 received photodynamic therapy plus argon plasma coagulation.
A further 22 received EMR plus photodynamic therapy with argon plasma coagulation.
The team reported that 32 patients underwent esophagectomy.
The 30-day mortality rate included 1 patient in the endotherapy group, and none in the surgical group.
No deaths from esophageal cancer occurred in either group.
The team found that cancer developed in 6% of endotherapy patients, and in none in the surgical cohort.
Major and minor complications occurred in 8% and 31% of endotherapy patients, respectively, and 13% and 63% of surgery patients.
Median cost to date was $40,079 for end therapy, and $66,060 for esophagectomy.
Dr Schembre's team concluded, "Both endotherapy and esophagectomy can effectively treat high-grade dysplasia and intramucosal carcinoma associated with Barrett's esophagus."
"Endotherapy is associated with a higher risk of tumor progression, although this is uncommon."
"Esophagectomy incurs higher initial costs and results in more frequent minor complications but is usually curative."