The Clinical Characteristics and Outcomes of Barrett's Cancer at a Single Institution in Korea

Kim, Sang Jung; Lee, Jun Haeng; Kim, Beom Jin; Rhee, Poong Lyul; Kim, Jae J; Rhee, Jong Chul; Kim, Kyoung Mee; Shim, Yong Mog

Abstract

BACKGROUND/AIMS
The prevalence of Barrett's esophagus might also be changing along with changes in the epidemiology of GERD, and the incidence of Barrett's cancer is expected to increase even more. The aim of this study is to evaluate the clinicopathologic features and outcome of the patients with Barrett's cancer and who were seen at a single institution over a period of 13 years.
METHODS
The records of 39 patients with the esophageal adenocarcinoma and who were treated at Samsung Medical Center from January 1995 to August 2008 were reviewed. Among them, 11 patients (28%) with histologically-confirmed Barrett's cancer were included in the study. The clinicopathological features, endoscopic manifestations and treatment outcome were evaluated.
RESULTS
The male to female ratio was 10:1. The mean age was 64 years. Most of the patients were diagnosed with Barrett's cancer after 2000, and there were three such patients (27.3%) in 2008. The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. The macroscopic types based on the endoscopic findings were as follows: 4 lesions with a type IIa appearance (36.4%) and 2 with a type IIb appearance (18.2%). The mean tumor size was 1.2 cm at the longest dimension and 0.8 cm at the shortest dimension. Tumor was located in the mucosal layer in six cases (54.5%) and the 5 cases (45.5%) showed submucosal invasion. Lymph node metastasis was found in one case (9.1%). All the cases underwent surgery, except one case for which the tumor was removed by endoscopic submucosal dissection. There was no recurrence during the follow up period.
CONCLUSIONS
As the incidence of Barrett's cancer is increasing, a standard surveillance program that includes the endoscopic biopsy method, the grading system for the dysplasia and the treatment modality should be established.