Regular endoscopic follow-up is advised for patients with Barrett's esophagus.
Researchers from Italy evaluated the incidence of esophageal adenocarcinoma in patients with Barrett's esophagus. They also assessed the impact of endoscopic surveillance on mortality from adenocarcinoma.
The team examined a cohort of 177 newly diagnosed Barrett's esophagus patients, between 1987 and 1997. In these patients, endoscopic and histological surveillance was recommended every 2 years.
The researchers determined the patients' follow-up status using hospital and registry office records, as well as using telephone calls to the patients.
|High-grade dysplasia was identified in 2% of patients.|
|American Journal of Gastroenterology|
The team excluded 3 patients with high-grade dysplasia at the time of enrollment, but completed follow-up in 166 patients (135 male). The mean length of endoscopic follow-up was 5.5 years.
The physicians found that low-grade dysplasia was present in 10% of the patients at the beginning of the study, and was identified during follow-up in a further 14%. However, the team determined, that in 75% of these cases, low-grade dysplasia was not confirmed on later biopsies.
High-grade dysplasia was identified during surveillance in 2% of patients. Of these, 1 had simultaneous adenocarcinoma, while 2 developed adenocarcinoma at a later stage.
During the course of the study, the team detected adenocarcinoma in 3% of patients (all male). Of these, 4 patients died, while 1 remains alive with advanced-stage tumor.
The research team calculated that the incidence of adenocarcinoma was 1 per 220 patient-years of total follow-up, or 1 per 183.6 patient-years in subjects undergoing endoscopy.
They found that the mean number of endoscopies performed for surveillance, rather than for symptoms, was 2.4 per patient.
Furthermore, during follow-up the cohort had a total of 528 examinations and over than 4000 biopsies.
Dr Massimo Conio's team concluded, "The incidence of adenocarcinoma in Barrett's esophagus is low, confirming recent data from the literature reporting an overestimation of cancer risk in these patients".
"In our patient cohort, surveillance involved a large expenditure of effort but did not prevent any cancer deaths".
"The benefit of surveillance remains uncertain".