BACKGROUND: Barrett's oesophagus carries a 30-fold to 40-fold increased risk of oesophageal cancer. It is unknown whether endoscopic surveillance programmes reduce mortality from oesophageal cancer. METHODS: A cohort study was undertaken of all 166 patients in whom the diagnosis Barrett's oesophagus had been established between 1973 and 1986. RESULTS: One hundred and fifty five of 166 patients could be traced (93%). During a mean follow up of 9.3 years (amounting to 1440 patient years) eight patients had developed oesophageal cancer at random intervals (one case in 180 patient years). All but one of the tumours were diagnosed at endoscopy for symptoms, three in the stage of carcinoma in situ. Risk factors for the development of oesophageal cancer were extensive Barrett's oesophagus exceeding 10 cm (p = 0.02) and Barrett's ulcer at the time of intake (p = 0.009). Seventy six patients were alive; three had undergone surgery for oesophageal cancer and were without recurrence respectively, 12.8 years, 12.1 years, and 7 months postoperatively. Seventy nine patients had died; five of them had developed oesophageal cancer, but in only two cases this had been the cause of death (2.5%). CONCLUSIONS: Oesophageal cancer is an uncommon cause of death in patients with Barrett's oesophagus. The patients of this cohort would not have benefited from an endoscopic surveillance programme.
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