Clinical research studyBarrett's Surveillance Identifies Patients with Early Esophageal Adenocarcinoma
Section snippets
Patient Population
The Institutional Review Board at the Veteran Administration Connecticut Healthcare System approved the study. We performed a retrospective review of consecutive patients with Barrett's esophagus who were prospectively followed in a Barrett's surveillance program and compared their outcome with consecutive patients with a new diagnosis of esophageal adenocarcinoma, identified at the same Veterans Affairs Medical Center between 1999 and 2005. Barrett's esophagus was defined as specialized
Surveillance
There were 248 patients with Barrett's esophagus who entered into a surveillance program from 1999 to 2005. During the surveillance period of 987 patient years, 5 (0.5% patient year) patients developed esophageal adenocarcinoma (surveillance cancers). During the same period and at our institution, 46 patients were diagnosed with new-onset esophageal adenocarcinoma, outside of our surveillance program and without a prior diagnosis of Barrett's esophagus (nonsurveillance cancers). Baseline
Discussion
We present a large single-center study comparing the outcome of Barrett's patients enrolled in a prospective surveillance program, and compared their disease stage and mortality with an unscreened, nonsurveillance patient cohort from the same institution who presented with esophageal adenocarcinoma. We found that patients enrolled in a Barrett's surveillance program benefited from an earlier stage of diagnosis of cancer compared with patients diagnosed with esophageal adenocarcinoma outside of
Conclusion
In this large retrospective cohort of patients with Barrett's esophagus, we observed that regular surveillance identifies patients with earlier stage cancer. The progression to adenocarcinoma in patients with Barrett's esophagus is very low, but patients with high-grade dysplasia have the highest risk of cancer on follow-up. Length of Barrett's segment was found to be a significant risk factor associated with progression to dysplasia. Unfortunately, we also have found that most patients with
References (35)
- et al.
Surveillance and survival in Barrett's adenocarcinomas: a population-based study
Gastroenterology
(2002) - et al.
Surveillance and survival in Barrett's adenocarcinoma: a population-based study
Gastroenterology
(2002) - et al.
The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's Esophagus Registry
Am J Gastroenterol
(1999) - et al.
Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data
Gastroenterology
(1999) - et al.
Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review
Gastroenterology
(2002) - et al.
Prevalence of Barrett's esophagus in asymptomatic individuals
Gastroenterology
(2002) Intestinal metaplasia at the gastroesophageal junction
Gastroenterology
(2004)- et al.
Small adenocarcinomas of the esophagogastric junction: association with intestinal metaplasia and dysplasia
Am J Gastroenterol
(2002) - et al.
Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma
Am J Gastroenterol
(1999) - et al.
Effect of a prior endoscopy on outcome of esophageal adenocarcinoma among United States veterans
Gastrointest Endosc
(2008)
The changing epidemiology of esophageal cancer
Semin Oncol
The role over diagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence
J Natl Cancer Inst
American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma
Gastroenterology
The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus
N Engl J Med
Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia
Cancer
Malignant progression in Barrett's esophagus: pathology and molecular biology
Recent Results Cancer Res
Impact of endoscopic biopsy surveillance of Barrett's oesophagus on pathological stage and clinical outcome of Barrett's carcinoma
Gut
Cited by (51)
Advances in Diagnostic, Staging, and Restaging Evaluation of Esophageal and Gastric Cancer
2024, Surgical Oncology Clinics of North AmericaA review of the incidence of adenocarcinoma detected during surveillance for Barrett's esophagus
2019, Human PathologyCitation Excerpt :Altogether, this study uses data from approximately 61 000 patients. The data for this study came from 55 previously reported longitudinal studies of Barrett's esophagus [3-51] (several studies were reported in one review). When a single institution reported their data several times, only the latest was used.
The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis
2018, GastroenterologyCitation Excerpt :First, we pooled all unadjusted data from 12 studies. Meta-analysis of these 12 studies13,15,16,24–28,30,33–35 showed that having a prior diagnosis of BE was associated with a 52% reduction in all-cause mortality (95% CI, 0.37–0.63) (Supplementary Figure 3). There was substantial heterogeneity present (I2 = 89%).
Screening and Surveillance of Barrett's Esophagus
2016, Barrett's Esophagus: Emerging Evidence for Improved Clinical PracticeEpidemiology of Barrett's Esophagus and Esophageal Adenocarcinoma
2015, Gastroenterology Clinics of North AmericaBarrett Esophagus
2015, Surgical Clinics of North America
Funding: None.
Conflict of Interest: The authors state that they have no conflicts of interest.
Authorship: All authors had access to the data and contributed to study design, data acquisition, and data analysis. All authors were involved in manuscript writing.