Regular endoscopic surveillance of patients with Barrett's esophagus was associated with diagnosis of esophageal adenocarcinoma when it was still treatable and may extend survival times, according to a multicenter prospective cohort trial published online April 22 in Gut.
The 5-year survival of patients diagnosed with neoplastic progression in the trial was not statistically different from 5-year survival among patients with Barrett's in whom no progression was found, report Florine Kastelein, MD, from the Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands, and colleagues. The study is the latest among several to show that endoscopic surveillance enables earlier detection of esophageal adenocarcinoma and improved survival, although some studies show no effect on mortality.
The study included 783 patients with Barrett's esophagus of at least 2 cm from 15 hospitals in the Netherlands, including three academic medical centers. At 3 years' median follow-up, 53 patients developed high-grade dysplasia or esophageal adenocarcinoma, for an incidence rate of 1.2 per 100 person-years. Sixty-six percent (35 patients) were classified as stage 0, 26% (14 patients) were stage 1, and 8% (4 patients) were stage 2.
The authors note that esophageal adenocarcinoma was found significantly later (P < .001) in the general population compared with in the surveillance group. In the Netherlands general population, 8855 patients were diagnosed with esophageal adenocarcinoma between 2004 and 2012. Of these, 1% were stage 0, 14% stage 1, 16% stage 2, 23% stage 3, and 46% stage 4.
Among the 53 patients with neoplastic progression in the trial cohort, 12 (23%) died after a median follow-up of 2 years. All-cause 5-year survival of patients with progression was 74% (95% confidence interval [CI], 60% - 87%). All-cause 5-year survival was 80% for stage 0 patients, 68% for stage 1 patients, and 33% for stage 2 patients, the authors report. The all-cause 5-year survival among patients with Barrett's without progression was 94% (95% CI, 92% - 96%).
In the general population, 6352 (72%) patients died after a median follow-up of 7 months. Stage 0 patients had an all-cause 5-year survival rate of 62%. All-cause 5-year survival was 65% for stage 1 patients, 30% for stage 2, 14% for stage 3, and 3% for stage 4.
Endoscopic exams performed in the trial adhered to guidelines from the American College of Gastroenterology, which advise surveillance every 3 to 5 years among patients with nondysplastic Barrett's. Among patients with low-grade dysplasia, guidelines call for an endoscopic exam every 6 to 12 months. Among patients with established high-grade dysplasia or adenocarcinoma, guidelines advise treatment.
"In conclusion, this study suggests that regular endoscopic surveillance of patients with [Barrett's esophagus] enables the detection of [esophageal adenocarcinoma] at an early and curable stage when endoscopic treatment is still feasible and leads to good survival. The results of this study therefore support current guidelines recommending endoscopic surveillance in patients with [Barrett's esophagus]."
The authors have disclosed no relevant financial relationships.
Gut. Published online April 22, 2015. Abstract
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