Esophageal adenocarcinoma is increasing in incidence, and has a high mortality unless detected early.
Currently, the only known risk factor associated with this cancer is Barrett's esophagus. However, whether endoscopic surveillance reduces morbidity and mortality is controversial.
Endoscopic cancer surveillance programs for Barrett's esophagus are not routinely practiced in the UK, and this is the first study to examine whether a rigorous surveillance protocol increases the detection rate of early esophageal cancer.
All patients with a diagnosis of Barrett's esophagus or associated adenocarcinoma, attending Havering Hospitals NHS Trust (Essex, England) between 1992 and 1998, were included.
A retrospective analysis of patients undergoing informal surveillance (96 patients, 1992-1997) was carried out, and a prospective analysis was conducted following the implementation of a rigorous protocol (108 patients, 1997-1998).
Over the same time periods, Barrett's associated cancers diagnosed in patients not undergoing surveillance were also analyzed (262 patients 1992-1997, 98 patients 1997-1998).
|Esophageal adenocarcinoma is increasing in incidence.|
|Digestive Diseases and Sciences|
From 1992 to 1997, one case of high-grade dysplasia was detected (n = 96, 1%). From 1997 to 1998, two cancers and three high-grade dysplasias were detected during rigorous surveillance (n = 108, 4.6%).
Three of these patients had curative esophagectomies (one high-grade dysplasia and two T1, N0, M0 tumors).
In 1992-1997, 10 patients were found to have cancer in previously undiagnosed Barrett's esophagus (n = 262, 3.8%).
Of 3/10 cancers treated surgically, one patient had a curative procedure (T1, N0, M0). In 1997-1998, 9 patients were found to have de novo Barrett's esophagus cancer (n = 88, 10%) and three had curative resections (T1, N0, M0).
In 2 of the patients with T1 lesions there was no endoscopic evidence of cancer, and detection was made as a result of the multiple biopsy protocol.
In conclusion, a rigorous biopsy protocol increases the detection of early cancer in Barrett's esophagus.