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Endoscopic surveillance of Barrett’s esophagus patients does not improve cancer survival
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Patients with Barrett’s esophagus who undergo endoscopic surveillance are not at decreased mortality risk from esophageal adenocarcinoma compared with those who do not, according to recent results.
In a case-control study, researchers compared the surveillance histories of 38 patients with Barrett’s esophagus (BE) who died because of esophageal (n=31) or gastroesophageal junction (n=7) adenocarcinoma before September 2007 with those of 101 matched controls with BE who did not die of either cancer during follow-up. All patients were members of Kaiser Permanente Northern California. Patients who underwent one or more surveillance endoscopies within 3 years of cancer diagnosis for cases or the corresponding date for matched controls were considered in surveillance.
No association was observed between surveillance at 3 years and mortality risk related to esophageal adenocarcinoma (adjusted OR=0.99; 95% CI, 0.36-2.75), with 55.3% of cases having received surveillance compared with 60.4% of controls. Factors associated with mortality included previous dysplasia and a BE length greater than 3 cm. While cases were more likely than controls to have either low- or high-grade dysplasia and longer BE length, adjustment for these factors did not influence the results of mortality risk analysis.
Exclusion of five patients who experienced treatment-related mortality and six who were unwilling or unable to undergo resection decreased the OR for mortality (OR=0.46; 95% CI, 0.13-1.64), but the association remained nonsignificant.
“Endoscopic surveillance of BE was not associated with any substantial decrease in the risk of death from EA within a large, community-based population,” the researchers concluded. “Randomized trials are needed to evaluate whether commonly used surveillance methods, combined with follow-up treatments, provide any overall mortality benefits to patients with BE. The results also suggest that alternative approaches, such as chemoprevention or ablation, warrant further evaluation to determine, in controlled studies, if they may provide other approaches to decrease cancer mortality.”
Disclosure: The researchers report no relevant financial disclosures.
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