GASTROENTEROLOGY ARTICLE OF THE WEEK
April 19, 2007
Wang KK. Esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2006;4:1221-1224.
1. Recommended (although controversial) screening intervals for patients with confirmed Barrett’s are
a. yearly EGD once Barrett’s diagnosed
b. EGD every 2 years if no evidence of dysplasia
c. EGD every 3-5 years if no dysplasia
d. EGD in 6 months if low grade dysplasia
e. EGD in 1 year if low grade dysplasia
f. EGD in 3 months if high grade dysplasia and no ablative therapy
True or False
2. Photodynamic therapy in patients with high grade dysplasia decreases risk of cancer to <1%
3. Anti-reflux surgery has no effect on the risk of cancer in patients with Barrett’s
4. Chronic esophageal strictures develop in about 30% of patients undergoing photodynamic ablation of Barrett’s
5. Chances of having metastasis if a small adenocarcinoma is identified with EUS features suggestive of only mucosal invasion is <3%
6. After finding adenocarcinoma in a 5mm nodule in an asymptomatic patient with Barrett’s, the next test should be a CT scan of the Chest to evaluate for metastasis
7. There is no need to do CT or PET scans in patients with small adenocarcinomas of the esophagus and an EUS showing only mucosal involvement with normal nodes
8. High dose proton pump inhibitors should be used in all Barrett’s patients with dysplasia to reduce risk of malignancy