[Barrett's esophagus: new developments in endoscopic surveillance].
Academisch Medisch Centrum, afd. Maag-, Darm- en Leverziekten, Meibergdreef 9, 1105 AZ Amsterdam.Nederlands tijdschrift voor geneeskunde 12/2003; 147(46):2268-74.
The current surveillance strategies for patients with a Barrett's oesophagus are hampered by the poor endoscopic visibility of early neoplastic lesions, the sampling error of random biopsies, the subjectivity of the histological evaluation, and the low incidence of carcinoma. New endoscopic techniques are available for a more reliable evaluation of a Barrett's oesophagus: high-resolution endoscopy, chromoendoscopy, fluorescence endoscopy and optical coherence tomography. The use of molecular markers will probably lead to a better risk stratification of patients. Detection of aneuploid cell populations and assessment of an increase of the number of cells in the S- and G2-phase are possible with DNA flow cytometry; flow cytometric abnormalities may be a more reliable predictor of carcinoma than histological assessment. A combined approach with the new endoscopic techniques and molecular markers may lead to a more efficient and cost-effective surveillance programme.
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ABSTRACT: Over the last few years developments have been concentrated on the diagnostic and therapeutic properties of bronchoscopy. Autofluorescence and fluorescence bronchoscopy significantly enhance the detection rate of premalignant and early neoplastic endobronchial lesions. Unfortunately, this technique is hampered by a low specificity. Endobronchial ultrasound examination is the first tool that has enabled the bronchoscopist to get an impression of the tracheal wall beyond its epithelial surface including the mediastinal and the hilar structures. Currently, the complexity of the procedure prevents its widespread application. Intervention bronchoscopy involves mechanical and laser removal of processes that may impede the central airways. Electrocauterization and laser dissection are regularly used to remove intrabronchial tumour depositions. Airway stenting is indicated if there are stenoses caused by compression from abnormalities located externally to the airways.Nederlands tijdschrift voor geneeskunde 07/2004; 148(26):1280-5.
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ABSTRACT: The objective of this study was to examine outcomes in patients undergoing esophageal resection for adenocarcinoma at our institution during a 20-year period and, in particular, to address temporal trends in long-term survival. Out of 470 patients who underwent esophagectomy for malignancy between September 1985 and September 2005, a total number of 175 patients presented with esophageal adenocarcinoma. Patients enrolled in this study included AEG (adenocarcinoma of the esophagogastric junction) type I tumors only. Time trends were studied comparing two decades, 9/1985 to 9/1995 (DI) and 10/1995 to 9/2005 (DII). The overall survival was significantly more favourable in patients undergoing esophageal resection for adenocarcinoma in the recent time period (DII, 10/1995 to 9/2005) as compared to the early time period (DI, 9/1985 to 9/1995) (log rank test: p = 0.0329). Significant differences in the recent decade were seen based on lower ASA-classifications, earlier tumor stages, and the operative procedure with a higher frequency of transhiatal resections (p < 0.05). 30-day mortality improved from 8.3% to 3.1% during the 20-year time-interval, thus without statistical significance. Based on our experience, overall survival is improving over time for adenocarcinoma of the esophagus. Factors that may play an important role in this trend include early diagnosis and improved patient selection through better preoperative staging, improved surgical technique with a tailored approach carefully evaluated by physiologic patient status, comorbidity and tumor extent.BMC Cancer 06/2007; 7(1):114. DOI:10.1186/1471-2407-7-114 · 3.36 Impact Factor
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