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Peter J. Kobes - One of the best experts on this subject based on the ideXlab platform.

  • 6967 Prevalence of villous histology or High Grade Dysplasia in different size polyps found on screening colonoscopies.
    Gastrointestinal Endoscopy, 2000
    Co-Authors: Peter J. Kobes, Kevin O'brien, Brian F. Sweeney, Nicholas Conger, Kevin A. Lang
    Abstract:

    Adenomatous Polyps(AP)are a frequent finding on colorectal cancer screening examinations. The presence of villous histology or High Grade Dysplasia on pathologic examination of an AP indicates a more advanced lesion. The goal of this study was to determine (1)the prevalence of villous histology or High Grade Dysplasia in AP removed during screening colonoscopies performed after a hemoccult positive stool or an abnormal flexible sigmoidoscopy and to (2)subcategorize the data based on the size of the AP. Methods:Colonoscopy and pathology reports were retrospectively reviewed on 1203 polyps removed during 665 colonoscopies.Polyps were divided by size into 3 categories:(1)1-5mm,(2)6-10mm, and (3)>10mm, and path reports were used to determine the prevalence of villous histology or High Grade Dysplasia.Results:The results are summarized in Table 1 Conclusions:There was an overall 11.6% prevalence of villous histology or High Grade Dysplasia in AP removed during colonoscopy. Diminuitive AP of less then 6mm had a 4.0% prevalence while AP 6-10mm in size were three times as likely(12.8%) and AP >10mm were eleven times as likely(44.8%) to have villous histology or High Grade Dysplasia.

  • Prevalence of villous histology or High Grade Dysplasia in different size polyps found on screening colonoscopies
    The American Journal of Gastroenterology, 2000
    Co-Authors: Peter J. Kobes
    Abstract:

    Purpose: Adenomatous Polyps (AP) are a frequent finding on colorectal cancer screening examinations. The presence of villous histology or High Grade Dysplasia on pathologic examination of an AP indicates a more advanced lesion. The goal of this study was to determine (1) the prevalence of villous histology or High Grade Dysplasia in AP removed during screening colonoscopies performed after a hemoccult positive stool or an abnormal flexible sigmoidoscopy and to (2) subcategorize the data based on the size of the AP.

Praful Patel - One of the best experts on this subject based on the ideXlab platform.

  • A UK BASED COST-UTILITY ANALYSIS OF RADIOFREQUENCY ABLATION OR OESOPHAGECTOMY FOR THE MANAGEMENT OF High-Grade Dysplasia IN BARRETT'S OESOPHAGUS
    Alimentary Pharmacology and Therapeutics, 2010
    Co-Authors: Philip Christopher Boger, David Turner, Paul Roderick, Praful Patel
    Abstract:

    Background In the UK, oesophagectomy is the current recommendation for patients with persistent High-Grade Dysplasia in Barrett's oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results. Aim To undertake a cost utility analysis comparing these two strategies. Methods We constructed a Markov model to simulate the natural history of a cohort of patients with High-Grade Dysplasia in Barrett's oesophagus undergoing one of two treatment options; (i) Oesophagectomy (ii) Radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for High-Grade Dysplasia recurrence or persistence. Results In the base case analysis radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost effective option requires a radiofrequency ablation treatment failure rate (High-Grade Dysplasia persistence or progression to cancer) of greater than 44%, or an annual risk of High-Grade Dysplasia recurrence or progression to cancer in the ablated oesophagus of greater than 15% per annum. There was an 85% probability that radiofrequency ablation remained cost effective at the NICE willingness to pay threshold range of £20000-30000. Conclusion Radiofrequency ablation is likely to be a cost effective option for High-Grade Dysplasia in Barrett's oesophagus in the UK.

  • A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of High-Grade Dysplasia in Barrett’s oesophagus
    Alimentary pharmacology & therapeutics, 2010
    Co-Authors: Philip Boger, Paul Roderick, David A. Turner, Praful Patel
    Abstract:

    Background: in the UK, oesophagectomy is the current recommendation for patients with persistent High-Grade Dysplasia in Barrett’s oesophagus. Radiofrequency ablation is an alternative new technology with promising early trial results. Aim: to undertake a cost–utility analysis comparing these two strategies. Methods: we constructed a Markov model to simulate the natural history of a cohort of patients with High-Grade Dysplasia in Barrett’s oesophagus undergoing one of two treatment options: (i) oesophagectomy or (ii) radiofrequency ablation followed by endoscopic surveillance with oesophagectomy for High-Grade Dysplasia recurrence or persistence. Results: in the base case analysis, radiofrequency ablation dominated as it generated 0.4 extra quality of life years at a cost saving of £1902. For oesophagectomy to be the most cost-effective option, it required a radiofrequency ablation treatment failure rate (High-Grade Dysplasia persistence or progression to cancer) of >44%, or an annual risk of High-Grade Dysplasia recurrence or progression to cancer in the ablated oesophagus of >15% per annum. There was an 85% probability that radiofrequency ablation remained cost-effective at the NICE willingness to pay threshold range of £20 000–30 000. Conclusion: radiofrequency ablation is likely to be a cost-effective option for High-Grade Dysplasia in Barrett’s oesophagus in the UK.

Tom R. Demeester - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic resection and ablation versus esophagectomy for High-Grade Dysplasia and intramucosal adenocarcinoma.
    The Journal of thoracic and cardiovascular surgery, 2010
    Co-Authors: Jörg Zehetner, Steven R. Demeester, Jeffrey A. Hagen, Shahin Ayazi, Florian Augustin, John C. Lipham, Tom R. Demeester
    Abstract:

    Background Esophagectomy has been the traditional therapy for High-Grade Dysplasia and intramucosal adenocarcinoma. New endoscopic approaches allow treatment of these lesions with esophageal preservation. The aim of this study was to compare the outcome of endoscopic therapy with esophagectomy for High-Grade Dysplasia and intramucosal cancer. Methods A retrospective review was performed of all patients treated for High-Grade Dysplasia or intramucosal adenocarcinoma from 2001 to April 2010. Results Endoscopic therapy was performed in 40 patients (High-Grade Dysplasia = 22, intramucosal cancer = 18) and esophagectomy in 61 patients (High-Grade Dysplasia = 13, intramucosal cancer = 48). Endotherapy consisted of 102 endoscopic resections and 79 mucosal ablations (median 3 interventions per patient). In the endotherapy group, intramucosal cancer was completely resected in all patients. At last assessment, 10 patients have been converted to intestinal metaplasia without Dysplasia and 21 to no residual intestinal metaplasia. Five patients have follow-up biopsy procedures pending after recent ablation, and esophagectomy was performed in 3 patients for failed endotherapy. A laparoscopic Nissen fundoplication has been performed in 8 patients after eradication of intestinal metaplasia. Esophagectomy resected the mucosal disease with negative margins in all patients. Compared with esophagectomy, endotherapy was associated with significantly lower morbidity (39% vs 0; P P  = .0026). Conclusions Endoscopic therapy for High-Grade Dysplasia or intramucosal cancer has lower morbidity than an esophagectomy and similar survival during short-term follow-up, but required multiple procedures in most patients. Both therapies are appropriate options, but preservation of the esophagus allows the option of a fundoplication for reflux control, perhaps further improving long-term quality of life.

  • Vagal-Sparing Esophagectomy: The Ideal Operation for Intramucosal Adenocarcinoma and Barrett with High-Grade Dysplasia
    Annals of surgery, 2007
    Co-Authors: Christian G. Peyre, Steven R. Demeester, Jeffrey A. Hagen, Shahin Ayazi, John C. Lipham, Christian Rizzetto, Neeraj Bansal, Andrew Tang, Jessica M. Leers, Tom R. Demeester
    Abstract:

    Objective: Our aim was to compare outcome of vagal-sparing esophagectomy with transhiatal and en bloc esophagectomy in patients with intramucosal adenocarcinoma or High-Grade Dysplasia. Background Data: Intramucosal adenocarcinoma and High Grade Dysplasia have a low likelihood of lymphatic or systemic metastases and esophagectomy is curative in most patients. However, traditional esophagectomy is associated with significant morbidity and altered gastrointestinal function. A vagal-sparing esophagectomy offers the advantages of complete disease removal with the potential for reduced morbidity and a better functional outcome. Method: Retrospective review of outcome in patients with intramucosal adenocarcinoma or High Grade Dysplasia that had a vagal-sparing (n = 49), transhiatal (n = 39) or en bloc (n = 21) esophagectomy. Results: The length of hospital stay and the incidence of major complications was significantly reduced with a vagal-sparing esophagectomy compared with a transhiatal or en bloc resection. Further, postvagotomy dumping and diarrhea symptoms were significantly less common, and weight was better maintained postoperatively with a vagal-sparing esophagectomy. Recurrent cancer has developed in only 1 patient. Conclusion: Survival with intramucosal adenocarcinoma or Barrett's with High-Grade Dysplasia is independent of the type of resection. A vagal-sparing esophagectomy is associated with significantly less perioperative morbidity and a shorter hospital stay than a transhiatal or en bloc esophagectomy. Further, late morbidity including weight loss, dumping, and diarrhea are significantly less likely after a vagal-sparing approach. Consequently a vagal-sparing esophagectomy is the preferred procedure for patients with intramucosal adenocarcinoma or High Grade Dysplasia.

Kevin A. Lang - One of the best experts on this subject based on the ideXlab platform.

  • 6967 Prevalence of villous histology or High Grade Dysplasia in different size polyps found on screening colonoscopies.
    Gastrointestinal Endoscopy, 2000
    Co-Authors: Peter J. Kobes, Kevin O'brien, Brian F. Sweeney, Nicholas Conger, Kevin A. Lang
    Abstract:

    Adenomatous Polyps(AP)are a frequent finding on colorectal cancer screening examinations. The presence of villous histology or High Grade Dysplasia on pathologic examination of an AP indicates a more advanced lesion. The goal of this study was to determine (1)the prevalence of villous histology or High Grade Dysplasia in AP removed during screening colonoscopies performed after a hemoccult positive stool or an abnormal flexible sigmoidoscopy and to (2)subcategorize the data based on the size of the AP. Methods:Colonoscopy and pathology reports were retrospectively reviewed on 1203 polyps removed during 665 colonoscopies.Polyps were divided by size into 3 categories:(1)1-5mm,(2)6-10mm, and (3)>10mm, and path reports were used to determine the prevalence of villous histology or High Grade Dysplasia.Results:The results are summarized in Table 1 Conclusions:There was an overall 11.6% prevalence of villous histology or High Grade Dysplasia in AP removed during colonoscopy. Diminuitive AP of less then 6mm had a 4.0% prevalence while AP 6-10mm in size were three times as likely(12.8%) and AP >10mm were eleven times as likely(44.8%) to have villous histology or High Grade Dysplasia.

Rosangela Filiberti - One of the best experts on this subject based on the ideXlab platform.