NEW YORK (Reuters Health) Sep 14 - If endoscopic ablation of Barrett's esophagus doesn't destroy all the involved epithelium, metaplastic glands can end up buried under a layer of neosquamous epithelium, a new paper warns.
How often this happens, and how much it matters, isn't clear yet, the authors say.
Dr. Stuart Jon Spechler of the Dallas VA Medical Center, a coauthor on the paper, told Reuters Health by email that metaplasia buried in the lamina "may have malignant potential and, therefore, it is important to know how often endoscopic ablation results in buried metaplasia before adopting a policy of endoscopic ablation for all patients with Barrett's esophagus."
As reported online August 9th in the American Journal of Gastroenterology, the researchers reviewed the literature and found 40 articles on the results of photodynamic therapy and radiofrequency ablation for Barrett's esophagus.
Nine of the articles described 34 patients with neoplasia in buried metaplasia. Thirty-one of these cases followed photodynamic therapy and the remaining three were found after argon plasma coagulation or laser ablation.
Five studies showed the prevalence of buried metaplasia before ablation to range from 0% to 28%.
In 22 reports on photodynamic therapy in 953 patients, buried metaplasia was found in 135 (14.2%). In 18 reports on radiofrequency ablation in 1004 patients, buried metaplasia was found in only 9 (0.9%).
But "none of the reports described specifically whether biopsy specimens of neosquamous epithelium contained sufficient subepithelial lamina propria to be informative for the evaluation of buried metaplasia," according to Dr. Spechler and colleagues.
Buried metaplasia, he told Reuters Health, "is reported less frequently after radiofrequency ablation than after other endoscopic ablation techniques like photodynamic therapy."
"However," he added, "we also concluded that available reports do not provide crucial information on the adequacy of biopsy specimens and, therefore, the frequency and importance of buried metaplasia after endoscopic ablation remain unclear."
SOURCE: http://bit.ly/oQKOBg
Am J Gastroenterol 2011.
How often this happens, and how much it matters, isn't clear yet, the authors say.
Dr. Stuart Jon Spechler of the Dallas VA Medical Center, a coauthor on the paper, told Reuters Health by email that metaplasia buried in the lamina "may have malignant potential and, therefore, it is important to know how often endoscopic ablation results in buried metaplasia before adopting a policy of endoscopic ablation for all patients with Barrett's esophagus."
As reported online August 9th in the American Journal of Gastroenterology, the researchers reviewed the literature and found 40 articles on the results of photodynamic therapy and radiofrequency ablation for Barrett's esophagus.
Nine of the articles described 34 patients with neoplasia in buried metaplasia. Thirty-one of these cases followed photodynamic therapy and the remaining three were found after argon plasma coagulation or laser ablation.
Five studies showed the prevalence of buried metaplasia before ablation to range from 0% to 28%.
In 22 reports on photodynamic therapy in 953 patients, buried metaplasia was found in 135 (14.2%). In 18 reports on radiofrequency ablation in 1004 patients, buried metaplasia was found in only 9 (0.9%).
But "none of the reports described specifically whether biopsy specimens of neosquamous epithelium contained sufficient subepithelial lamina propria to be informative for the evaluation of buried metaplasia," according to Dr. Spechler and colleagues.
Buried metaplasia, he told Reuters Health, "is reported less frequently after radiofrequency ablation than after other endoscopic ablation techniques like photodynamic therapy."
"However," he added, "we also concluded that available reports do not provide crucial information on the adequacy of biopsy specimens and, therefore, the frequency and importance of buried metaplasia after endoscopic ablation remain unclear."
SOURCE: http://bit.ly/oQKOBg
Am J Gastroenterol 2011.
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου