Barrett's esophagus patients preferred endoscopic intervention for esophageal adenocarcinoma

Patients with Barrett’s esophagus preferred endoscopic ablation over chemoprevention for prevention of esophageal adenocarcinoma, according to study data.

“In a hypothetical scenario, assuming comparable efficacy and known risks, more patients with Barrett’s esophagus [BE] would choose an endoscopic intervention than chemoprevention for esophageal cancer prevention,” Patrick S. Yachimski, MD, from the division of gastroenterology, hepatology and nutrition at Vanderbilt University Medical Center in Nashville, told Healio Gastroenterology. “Understanding such patient preferences and the motivations behind these preferences may have implications for design of future esophageal cancer prevention strategies.”

Patrick S. Yachimski

Researchers aimed to learn whether patients with nondysplastic BE in a surveillance program preferred endoscopic intervention or chemoprevention to protect against the development of esophageal adenocarcinoma (EAC) and to learn if altering endoscopic surveillance frequency affects patient selection of either option. Researchers surveyed 81 participants with nondysplastic BE (65% men; 96% white; mean age, 60.2 years) enrolled at Vanderbilt University Medical Center, University of Colorado Hospital and the Veterans Administration Eastern Colorado Health Care System between May 2011 and October 2013.

Researchers described the risks and benefits of the two treatments anonymously to patients. They explained treatment A (ablation) as an upper endoscopic treatment to remove BE tissue and reduce lifetime EAC risk by 50% (from 10% to 5%). They told patients treatment B (aspirin) was a once daily over-the-counter pill to reduce lifetime EAC risk by 50% (from 10% to 5%). Participants were asked if they would be willing to undergo each treatment if surveillance endoscopy was required every 3-5 years, every 10 years or never.

When surveillance endoscopy was required every 3-5 years, 78% of patients chose ablation compared with 53% who chose aspirin (P<.01). The researchers found no differences in age, sex, education level or history of cancer, heart disease or ulcer in patients who chose ablation vs. those who chose aspirin. Altering frequency of surveillance endoscopy had no significant influence on patients’ willingness to undergo either treatment.

Hashem B. El-Serag

This study “is an important contribution to the growing literature on shared decision-making in gastroenterology and hepatology,” according to an accompanying editorial written by Aanand D. Naik, MD, and Hashem B. El-Serag, MD, MPH, from the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas.

The study’s strength is that its participants share similarities with patients at risk for BE, and among these typical patients, 16% endorsed neither method and 47% were willing to try both methods, according to Naik and El-Serag. However, the study’s limitations included inferences about the efficacy of ablation that are not well-supported, a potential framing bias resulting from endoscopy being consistently presented before oral chemoprevention, and a lack of a sensitivity analysis that varied estimates of benefit from ablation.

“These limitations may result in an artificially higher preference for surveillance endoscopy on the questionnaire compared with its actual selection in routine clinical practice,” they wrote.

For more information:

Yachimski P. Clin Gastroenterol Hepatol. 2015;doi:10.1016/j.cgh.2014.03.017.

Naik AD. Clin Gastroenterol Hepatol. 2015;doi:10.1016/j.cgh.2014.05.004.

Disclosure: The researchers report no relevant financial disclosures.