Introduction The British Society of Gastroenterology recommends biennial endoscopic screening of patients with known Barrett’s. Despite being widely employed the efficacy of surveillance is contested as the assumed 0.5% per year progression from metaplasia to cancer is disputed.(1) This study aims to evaluate the efficacy of detection of Barrett’s related cancer through screening within the Imperial College NHS Trust.
Methods We retrospectively analysed endoscopy and pathology reports of all patients who received an endoscopy for Barrett’s oesophagus within a 5 year period from 2007 to 2012. Patients presenting with established dysplasia or adenocarcinoma were excluded and only those with confirmed Barrett’s oesophagus were considered. The surveillance regime in this period was in accordance with the British Society of Gastroenterology guidelines. All endoscopies were conducted by Imperial College NHS gastroenterologists within Imperial Trust sites.
Results Over 54 months 326 patients underwent endoscopic surveillance of Barrett’s oesophagus with a mean follow-up of 36 months. 73 (22%) patients stopped surveillance in this period. Early Adenocarcinoma and High Grade Dysplasia was reported in 2 (0.6%) and 3 (0.9%) patients respectfully. Providing a 0.2% progression to adenocarcinoma per year and a 0.5% progression to High Grade Dysplasia or cancer per year. This gave a cancer incidence in Barrett’s oesophagus of 1 per 492 patient years of surveillance. All three of the HGD patients underwent endoscopic therapy and have successfully eradicated dysplasia and Barrett’s. Both cancer patients were unsuitable for endoscopic therapy. 1 received surgical treatment and 1 received radiotherapy.
Conclusion The risk of progression to cancer is lower than previously anticipated. We estimate the cost of a single surveillance endoscopy at £400, thus surveillance costs are £124,000 per cancer diagnosis. The mean age of adenocarcinoma diagnosis through surveillance is 68.1(2) and with average male life expectancy of 78, the cost of diagnosis is approximately £12,400 per year saved. This assumes all cancers detected via surveillance are curable and does not account for any subsequent treatment or follow-up costs, therefore this is likely to be a fractiont of the true cost. NICE state that £20,000-£30,000 is a cost-effective range per quality adjusted life year saved. In light of this we recommend a more stratified, cost effective screening programme be considered.
Disclosure of Interest None Declared
Kahrilas PJ. The Problems with Surveillance of Barrett’s Esophagus. The New England journal of medicine 2011; 365(15): pp. 1437–1438.
Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s oesophagus. New England Journal of Medicine 2011; 365(15): pp. 1375–1383.
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