COMMENTARY

Risk for Progression to Cancer in Barrett's Esophagus

David A. Johnson, MD

Disclosures

November 04, 2011

In This Article

Patients With Nondysplastic Barrett's Esophagus Have Low Risks for Developing Dysplasia or Esophageal Adenocarcinoma

Wani S, Falk G, Hall M, et al
Clin Gastroenterol Hepatol. 2011;9:220-227

Study Summary

Wani and coworkers raise a challenge to the cost-effectiveness of screening and/or BE ablative interventions. To date, the justification for endoscopic biopsy surveillance in patients with BE comes from the findings of observational studies that have suggested that early detection of esophageal adenocarcinoma (EAC) improves survival. In this study from 5 tertiary referral centers, investigators evaluated the incidence and progression of EAC and high-grade dysplasia in a prospective cohort of 1204 patients (94% white; 88% men; mean age, 59.3 years). All patients had nondysplastic BE with confirmed SCM and received routine biopsies that were interpreted by an expert pathologist at each of the participating institutions.

During a mean follow-up of 5.52 years (6644.5 patient-years), the annual incidence rates of EAC and high-grade dysplasia were 0.27% and 0.48%, respectively, and mean time to development was 5.3 and 5.6 years, respectively. Cancer-free survival at 5, 8, and 10 years was 98.6%, 97.5%, and 97.1%. A higher annual incidence rate of EAC and dysplasia (combined) was seen in patients with BE length ≥ 6 cm, compared with BE length < 6 cm (1.47% vs 0.34%).

Viewpoint

The incidence rates of EAC and high-grade dysplasia are approximately half the magnitude of those from recent studies. This raises the question of cost-effectiveness for current surveillance intervals. Of interest, a prior analysis[1] estimated that the annual incidence of EAC would need to be > 1.9% per year for surveillance of nondysplastic BE at 5-year intervals to be cost-effective.

Abstract

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