cqvip:Surgical esophagectomy, intensive endoscopic surveillan- ce,and mucosal ablative techniques, particularly photodynamic therapy (PDT), h ave been proposed as possible management strategies for Barrett’s high-grade d ysplasia (HGD). Each option has advantages and disadvantages, and no firm consen sus exists for the preferred strategy at this time. The purpose of this pilot st udy was to gain insight into patient preferences in Barrett’s HGD management. T wenty patients with Barrett’s esophagus were enrolled in a questionnaire study. The three possible management options for Barrett’s HGD including each option ’s potential benefits and harms were presented to the subject in a formalized p resentation that was designed to be easily comprehendible by patients. The subje cts rated each strategy using a health-related quality of life instrument and c hose one of the management strategies assuming they were found to have HGD. The average feeling thermometer rating scale values for the management strategies we re as follows: endoscopic surveillance,79; esophagectomy, 46; and PDT, 60. When asked to choose a strategy, 14 (70%) chose endoscopic surveillance,3 (15%) cho se esophagectomy, and 3 (15%) chose PDT. These findings were statistically sign ificant (P = 0.0024). The patients who chose endoscopic su- rveillance felt “comfortable" with endoscopy,while the most common concern ab out esophagectomy,and PDT was the risk of death and the unknown risk of recurren ce, respectively. In summary, when patients with Barrett’s esophagus were prese nted with three options to manage HGD, the majority chose endoscopic surveillanc e. Familiarity with endoscopic surveillance was the predominant reason for the c hoice.
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