MANAGEMENT OF BARRETT'S ESOPHAGUS - CME Conferences

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3 rd Annual Essentials in Primary CareSummer Conference: Session 1Thursday, July 26, 2012FUNDOPLICATION DOES NOT DECREASE THERISK OF ESOPHAGEAL CANCER IN GERD• Review of VA data base from 1986-199097.5% men; mean age 55 yrsFollow-up > 10 yrs for all• GERD with fundo: 946 (8 cancer) (risk ratio=1.9)• GERD without fundo: 1,892 (8 cancer)• No GERD: 5,676 (0 cancer)• Conclusion: “GERD is a risk factor foresophageal cancer, but there is insufficientevidence that fundoplication reduces that risk”(Tran et al: Am J Gastro 2005; 100: 1002)MEDICAL VS SURGICALTREATMENT?“When you come to a fork in the road,TAKE IT”Yogi BerraDonald Castell, MDManagement of Barrett’s Esophagus
3 rd Annual Essentials in Primary CareSummer Conference: Session 1Thursday, July 26, 2012BARRETT’S SURVEILLANCE GUIDELINESACG 2008–The grade of dysplasia determines thesurveillance interval– No dysplasia in 2 consecutive samples: every 3 years– LGD: every year until no dysplasia– HGD: intensive surveillance (q 3 months) orintervention; particularly for mucosal irregularity ormulti-focal (>5 crypts)MANAGEMENT OF HGD IN BARRETT’S• Intensive surveillance• Surgery• Endoscopic–Ablation–Mucosectomy/dissectionDonald Castell, MDManagement of Barrett’s Esophagus
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MANAGEMENT OF BARRETT'S ESOPHAGUS - CME Conferences

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