Adenocarcinoma in Patients With Barrett's Esophagus
Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. N Engl J Med. 2011;365:1375-1383.
Summary
How strong is the relationship between Barrett's esophagus and cancer? To answer this question, the authors conducted a cohort study of 11,028 patients with documented Barrett's esophagus in Denmark and looked at the number of new cases of adenocarcinoma of the esophagus that developed over approximately 5 years. They confirmed an 11.3-fold increased risk for this tumor compared with expected numbers in the background population (95% confidence interval [CI], 8.8-14.4). However, the annual risk was only 0.12%, much lower than the previously estimated risk of about 0.5%.
Viewpoint
Clinicians have long been aware of the increased risk for lower esophageal cancer in patients with Barrett's esophagus, which resulted in the current clinical strategy for managing these patients (ie, careful surveillance and, when indicated, prophylactic surgery). This study suggests that the risk for cancer is much lower than previously determined, implying that in the absence of dysplasia, surveillance may not be indicated. The study was large and contained detailed pathologic data, and it is reasonable to assume that the results apply to other populations. On the basis of this report, clinicians will need to reassess their approach to managing patients with Barrett's esophagus.
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Cite this: Albert B. Lowenfels. Best Research Developments in Surgery: 2011 - Medscape - Nov 23, 2011.
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