Quality of Life After Esophagectomy and Endoscopic Therapy for Barrett's Esophagus with High-Grade Dysplasia Or Intra-Mucosal Carcinoma

Abstract

Background: Esophagectomy (EG) and endoscopic therapy (ET) have been used to eradicate Barrett's esophagus with early neoplasia (BEN). Surgical patients endure alterations in anatomy while ET patients must undergo continued surveillance and harbor some uncertainty about their ultimate cure. The relative effect each therapy has on quality of life is unknown. Methods: SF-36 and Gastrointestinal Quality of Life Index (GIQLI) surveys were sent to all surviving patients who underwent either EG or ET at our institution over the last 9 years and were at least 1 year out from treatment. Because age influences QOL scores, we divided each group into ages 45-64 and 65 and older. Results: 32 patients underwent EG and 62 completed ET for BEN at VMMC between 1998 and 2006. 11 have died (1 ET related to treatment, 1 ET from esophageal cancer), 6 have been lost to follow-up. Surveys were sent to 77 patients and completed by 13 EG (50%) and by 28 ET patients (55%). 1 ET survey was excluded due to multiple incomplete responses. Mean age was higher in the ET group (69 vs. 62 p = 0.05) but pre-treatment ASA scores were similar. The EG group consisted of 8 younger and 5 older patients and the ET group had 11 and 16, respectively. The average time between treatment and survey was 4 years in the ET group and 5 years in the EG group. There were no significant differences in SF-36 scores between EG and ET patients except for superior physical functioning among EG patients among older patients. Mean scores for SF-36 were better in 7 of 8 categories among younger ET patients than younger EG patients but did not reach significance. The opposite was true for older patients where scores in 7 of 8 categories were higher among the EG group, without reaching significance. GIQLI scores tended to be higher among younger ET patients than young EG patients but did not reach significance (p = 0.08). There was no observable difference among older patients. Conclusions: EG and ET for BEN appear to have similar impact on QOL several years after treatment. QOL impact may be greater on younger patients undergoing EG. EG may have less QOL impact on older patients or EG may select healthier patients. Larger, prospective studies are warranted.