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1.
Gastrointest Endosc ; 75(5): 938-44, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22381529

RESUMO

BACKGROUND: Whether early Barrett's neoplasia has a predilection for particular spatial locations in shorter segment disease is currently unknown. Anatomic factors may play a role in lesion location because of differing levels of mucosal acid exposure. OBJECTIVE: To identify high-risk lesion locations, which has important implications for surveillance strategies. DESIGN: We interrogated a prospectively maintained database of patients who underwent endoscopic resection (ER) for Barrett's neoplasia at 2 Australian tertiary centers. Lesions targeted for ER were characterized and their location in the distal esophagus was noted as on a clock face. A Z test of proportions was used to test for deviation from uniformity in the distribution of lesions. SETTING: Two Australian tertiary centers. PATIENTS: Patients who underwent ER for Barrett's neoplasia. MAIN OUTCOME MEASUREMENTS: Lesion location in the distal oesophagus, resected specimen histology. RESULTS: A total of 146 consecutive patients had ER for biopsy-proven high-grade dysplasia or esophageal adenocarcinoma. A total of 75 patients had Barrett's segment length of 5 cm or less and a visible lesion. Five patients had 2 visible lesions giving a total of 80 lesions. ER of 66 lesions (82.5%) led to the identification of advanced pathology: 37 high-grade dysplasia (46%), 24 mucosal adenocarcinoma (30%), 5 submucosal adenocarcinoma (6%). Of a total of 80 lesions, 43 (53.8%) (95% CI, 42.9%-64.7%) were centered within the 2- to 5-o'clock arc, comprising 25% of the circumference. This area also accounted for 36 (54.5%) of the 66 lesions with advanced histology (95% CI, 42.5%-66.5%). All confidence intervals lie wholly above the 25% expected in a uniform circular distribution (P < .05). LIMITATIONS: Observational study in a tertiary center. CONCLUSIONS: In Barrett's maximal segments of 5 cm or less, the 2- to 5-o'clock arc, accounts for approximately 50% of macroscopically visible lesions and associated early neoplasia. This finding has important implications for surveillance strategies.


Assuntos
Adenocarcinoma/patologia , Esôfago de Barrett/patologia , Neoplasias Esofágicas/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esôfago de Barrett/cirurgia , Transformação Celular Neoplásica/patologia , Intervalos de Confiança , Neoplasias Esofágicas/cirurgia , Esofagoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
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