Patients with Barrett’s esophagus who develop esophageal adenocarcinoma have significantly better outcomes when their cancer is detected by surveillance endoscopy, according to the results of a cohort study published in Gut.
“With the emergence of large integrated electronic medical data repositories, it is possible to address some of the lingering comparative effectiveness questions related to endoscopic surveillance of BE,” Hashem B. El-Serag, MD, MPH, from the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, and colleagues wrote. “Our objective is to compare the effectiveness of endoscopic surveillance of BE versus non-surveillance strategies for [esophageal adenocarcinoma (EAC)] diagnosis and cancer-related outcomes,” using national VA datasets.
Hashem B. El-Serag
Researchers identified 29,536 patients with BE diagnosed from October 2003 through September 2009. Those with conditions that affect overall survival were excluded.
Throughout a mean follow-up period of 5 years, 424 patients developed EAC, 49.3% of whom were diagnosed by surveillance endoscopy. Among those whose EAC was diagnosed by non-BE surveillance endoscopy, 17.2% were BE surveillance program failures.
Patients whose EAC was diagnosed by surveillance endoscopy were more likely to be diagnosed at stage 0 or 1 (74.7% vs. 56.2%; P < .001), have longer survival (median 3.2 vs. 2.3 years; P < .001) and have lower cancer-related mortality (34% vs. 54%; P < .0001). There was also a trend among these patients to undergo esophagectomy (51.2% vs. 42.3%; P = .07).
Multivariate Cox proportional hazards modeling showed BE surveillance endoscopy was associated with a decreased risk for cancer-related mortality (HR = 0.47; 95% CI, 0.35-0.64), which was mostly explained by the early stage of EAC at diagnosis, the researchers wrote.
Multivariable analysis showed the adjusted HR for overall death in patients with cancer in a prior surveillance program was 0.63 (95% CI, 0.47-0.84) vs. patients with cancer not in a surveillance program.
“In summary, EACs detected among patients in a BE surveillance program were associated with improved survival compared with symptom-detected EACs,” the researchers concluded. “These results support further evaluations regarding whether surveillance is associated with a net survival benefit among all patients with BE and on improving surveillance tools.” – by Adam Leitenberger
The researchers report no relevant financial disclosures.