A team from Leicester General Hospital, Leicester, England and Hammersmith Hospital, London, England, reviewed the benefit of an endoscopic surveillance program, for patients with Barrett's esophagus.
409 patients in whom Barrett's esophagus was identified between1984 and 1994 were included in the observational study. 143 were entered into the annual surveillance program.
Mortality and development of dysplasia and cancer were the main outcomes monitored.
The average period of surveillance was 4.4 years. 55 patients were reassessed in 1994, but only eight remained in the program in 1999. Withdrawal was due to death (not from carcinoma of the esophagus), illness, or frailty.
Five of the patients who entered surveillance developed carcinoma of the esophagus. Only one cancer was identified as a result of a surveillance endoscopy, the others being detected during endoscopy to investigate new symptoms.
Only one case of esophageal cancer was identified by 745 surveillance endoscopies and 3000 biopsies.
Of the 266 patients who were not suitable for surveillance, one died from esophageal cancer and 103 from other causes.
Surveillance resulted in 745 endoscopies and about 3000 biopsy specimens.
Professor Raymond Playford said, on behalf of fellow team members, that, "The current surveillance strategy has limited value, and it may be appropriate to restrict surveillance to patients with additional risk factors such as stricture, ulcer, or long segment (>80 mm) Barrett's esophagus."