The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis
- Tusar K Desai1,
- Kumar Krishnan2,
- Niharika Samala1,
- Jashanpreet Singh1,
- John Cluley2,
- Subaiah Perla3,
- Colin W Howden2
- 1Department of internal medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
- 2Department of internal medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- 3Department of mathematics and statistics, Oakland University, Rochester, Michigan, USA
- Correspondence to Dr Tusar K Desai, 3535 W. 13 Mile Road, Suite 202, Royal Oak, MI 48073, USA;
Contributors Drs Desai and Howden were responsible for the intellectual design of the study and preparation of the manuscript. Drs Howden and Perla were responsible for statistical analysis. Drs Desai, Krishnan, Samala, Singh and Cluley were responsible for data acquisition. Dr Desai is the guarantor of the article.
- Revised 9 September 2011
- Accepted 10 September 2011
- Published Online First 13 October 2011
Introduction The risk of oesophageal adenocarcinoma (OAC) in non-dysplastic Barrett's oesophagus (BO) may have been overestimated. The objective was to estimate the incidence of OAC in patients with BO without dysplasia.
Methods The authors searched MEDLINE and EMBASE from 1966 to 2011 and performed a bibliographic review of previous publications, excluding abstracts, non-peer-reviewed publications and those not published in English, for prospective or retrospective studies of the incidence of OAC in patients with BO. They excluded patients with any degree of dysplasia at baseline and those without documented intestinal metaplasia. Studies were independently reviewed by two individuals. 57 of 3450 studies were included. The authors extracted information on number of patients with BO, length of follow-up, incident cases of OAC, mean age of patients, country of origin, whether prospective or retrospective, mean length of BO segments and mortality from causes other than OAC. Study quality was assessed by the Ottawa Newcastle criteria.
Results The 57 included studies comprised 11 434 patients and 58 547 patient-years of follow-up. The pooled annual incidence of OAC was 0.33% (95% CI 0.28% to 0.38%). Among 16 studies that provided appropriate information on mortality, there were 56 incident cases of OAC but 684 deaths from apparently unrelated causes. Among 16 studies that provided information on patients with short-segment BO, the annual incidence of OAC was only 0.19%.
Conclusions The incidence of OAC in non-dysplastic BO is around 1 per 300 patients per year. The incidence of OAC in short-segment BO is under 1 per 500 patients per year.
- Barrett's oesophagus
- oesophageal adenocarcinoma
- Barrett's carcinoma
- oesophageal cancer
- gastroesophageal reflux disease
- Helicobacter pylori–treatment
- duodenal ulcer
- proton pump inhibition
Previous presentation: These data were presented in poster form at the annual meeting of the American Gastroenterological Association in Chicago, Illinois, USA, on 7 May 2011.
Correction notice This article has been corrected since it was published Online First. The captions of figure 2 and 3 were changed, and the name of the American Gastroenterological Association was corrected.
Competing interests Dr Howden: consultant for Takeda, Otsuka, Boehringer-Ingelheim, Novartis, Eisai, XenoPort; speaking fees from Takeda, Otsuka, GlaxoSmithKline.
Provenance and peer review Not commissioned; externally peer reviewed.