TY - JOUR
T1 - Long-Term Quality of Life Following Endoscopic Therapy Compared to Esophagectomy for Neoplastic Barrett’s Esophagus
AU - Reddy, Chanakyaram A.
AU - Tavakkoli, Anna
AU - Chen, Vincent L.
AU - Korsnes, Sheryl
AU - Bedi, Aarti Oza
AU - Carrott, Philip W.
AU - Chang, Andrew C.
AU - Lagisetty, Kiran H.
AU - Kwon, Richard S.
AU - Elmunzer, B. Joseph
AU - Orringer, Mark B.
AU - Piraka, Cyrus
AU - Prabhu, Anoop
AU - Reddy, Rishindra M.
AU - Wamsteker, Erik
AU - Rubenstein, Joel H.
N1 - Funding Information:
Effort and funding provided by NIH U54CA163059 (JHR) and U01CA199336 (JHR). VLC was supported in part by a University of Michigan Training in Basic and Translational Digestive Sciences Grant (5T32DK094775).
Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/5
Y1 - 2021/5
N2 - Introduction: Endoscopic therapy (ET) and esophagectomy result in similar survival for Barrett’s esophagus (BE) with high-grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC), but the long-term quality of life (QOL) has not been compared. Aims: We aimed to compare long-term QOL between patients who had undergone ET versus esophagectomy. Methods: Patients were included if they underwent ET or esophagectomy at the University of Michigan since 2000 for the treatment of HGD or T1a EAC. Two validated survey QOL questionnaires were mailed to the patients. We compared QOL between and within groups (ET = 91, esophagectomy = 62), adjusting for covariates. Results: The median time since initial intervention was 6.8 years. Compared to esophagectomy, ET patients tended to be older, had a lower prevalence of EAC, and had a shorter duration since therapy. ET patients had worse adjusted physical and role functioning than esophagectomy patients. However, the adjusted odds ratio (OR) of having symptoms was significantly less with ET for diarrhea (0.287; 95% confidence interval [CI] = 0.114, 0.724), trouble eating (0.207; 0.0766, 0.562), choking (0.325; 0.119, 0.888), coughing (0.291; 0.114, 0.746), and speech difficulty (0.306; 0.0959, 0.978). Amongst the ET patients, we found that the number of therapy sessions and need for dilation were associated with worse outcomes. Discussion: Multiple measures of symptom status were better with ET compared to esophagectomy following treatment of BE with HGD or T1a EAC. We observed worse long-term physical and role functioning in ET patients which could reflect unmeasured baseline functional status rather than a causal effect of ET.
AB - Introduction: Endoscopic therapy (ET) and esophagectomy result in similar survival for Barrett’s esophagus (BE) with high-grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC), but the long-term quality of life (QOL) has not been compared. Aims: We aimed to compare long-term QOL between patients who had undergone ET versus esophagectomy. Methods: Patients were included if they underwent ET or esophagectomy at the University of Michigan since 2000 for the treatment of HGD or T1a EAC. Two validated survey QOL questionnaires were mailed to the patients. We compared QOL between and within groups (ET = 91, esophagectomy = 62), adjusting for covariates. Results: The median time since initial intervention was 6.8 years. Compared to esophagectomy, ET patients tended to be older, had a lower prevalence of EAC, and had a shorter duration since therapy. ET patients had worse adjusted physical and role functioning than esophagectomy patients. However, the adjusted odds ratio (OR) of having symptoms was significantly less with ET for diarrhea (0.287; 95% confidence interval [CI] = 0.114, 0.724), trouble eating (0.207; 0.0766, 0.562), choking (0.325; 0.119, 0.888), coughing (0.291; 0.114, 0.746), and speech difficulty (0.306; 0.0959, 0.978). Amongst the ET patients, we found that the number of therapy sessions and need for dilation were associated with worse outcomes. Discussion: Multiple measures of symptom status were better with ET compared to esophagectomy following treatment of BE with HGD or T1a EAC. We observed worse long-term physical and role functioning in ET patients which could reflect unmeasured baseline functional status rather than a causal effect of ET.
KW - Endoscopic mucosal resection
KW - Quality of life
KW - Radiofrequency ablation
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U2 - 10.1007/s10620-020-06377-1
DO - 10.1007/s10620-020-06377-1
M3 - Article
C2 - 32519141
AN - SCOPUS:85086164465
SN - 0163-2116
VL - 66
SP - 1580
EP - 1587
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 5
ER -