A large proportion of esophageal adenocarcinomas were diagnosed within 1 year after a negative index endoscopy in adults diagnosed with nondysplastic Barrett’s esophagus, or Barrett’s esophagus with low-grade dysplasia, according to results from a recent study.
“Based on a systematic review and meta-analysis of 24 cohort studies in adults with BE … followed for at least 3 years after negative index endoscopy …, we observed a high magnitude of missed [esophageal adenocarcinomas] … diagnosed within 1 year of negative index endoscopy,” Siddharth Singh, MBBS, from the Mayo Clinic in Rochester, Minn., and colleagues wrote. “Additional resources should be allocated to detect missed [esophageal adenocarcinomas].”
The research team examined 24 cohort studies found in MEDLINE, Embase and Web of Science from initiation of each study to May 31, 2015. The studies included data on adults with Barrett’s esophagus (BE), which included either baseline nondysplastic BE or BE with low-grade dysplasia. Data on incident or missed EACs after negative index endoscopy were available over at least a 3-year follow-up period.
The main outcome was the proportion of missed EACs (defined as being diagnosed within 1 year after negative index endoscopy) and incident EACs (diagnosed more than 1 year after initial endoscopy in which BE was diagnosed).
The researchers identified 820 total EACs found at follow-up, of which 25.3% were missed within 1 year of endoscopy. The other 74.7% were classified as incident EACs; however, the researchers wrote that there was substantial heterogeneity among the studies. In 15 studies where only the patients with nondysplastic BE were included, 23.9% of EACs were missed.
“These data persist over a wide variety of study types and chronological time periods of BE cohort studies,” the researchers wrote. “Additional studies need to be performed to determine if enhanced endoscopic detection using advanced imaging techniques, longer inspection time, an increased number of biopsies, and more assiduous application of the early repeat endoscopy (ie, within 1 year of diagnosis) would enable BE surveillance to reach its real potential in decreasing the burden of EAC; cost-effectiveness analyses of such an approach are warranted to understand the implications of these findings.” – by Suzanne Reist
Disclosures: Singh reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.