Surveillance and survival in Barrett's adenocarcinomas: a population-based study

Gastroenterology. 2002 Mar;122(3):633-40. doi: 10.1053/gast.2002.31879.


Background & aims: Guidelines recommend periodic endoscopic surveillance of Barrett's esophagus (BE) patients to detect and treat early esophageal adenocarcinomas; however, no trials or population-based studies exist. We evaluated the association between endoscopic surveillance of BE and survival among esophageal/gastric cardia adenocarcinoma patients.

Methods: We studied a cohort of 23 BE patients, among 589 esophageal or gastric cardia adenocarcinoma patients diagnosed between 1990-1998 at Northern California Kaiser Permanente (a large health maintenance organization). We measured the presence of BE, detection of cancer by endoscopic surveillance, cancer stage, mortality, and potential confounders.

Results: BE was diagnosed in 135 of 589 adenocarcinoma patients, with 23 BE patients diagnosed greater than 6 months before cancer was diagnosed. Among these 23 patients, 73% of the surveillance-detected cancer patients (n = 15) were alive at the end of follow-up, compared with none of the patients without surveillance-detected cancers (n = 8; P = 0.001). All surveillance-detected cancer patients had low-stage disease and none died directly from cancer. The surveillance/survival association was not substantially altered by stratification for age at BE diagnosis or other potential confounders.

Conclusions: Surveillance-detected BE-associated adenocarcinomas were associated with low-stage disease and improved survival. Additional studies are needed to evaluate potential biases and whether screening/surveillance programs decrease mortality among all patients in surveillance. Few patients (3.9%) had a BE diagnosed before their cancer. Thus, even if current surveillance techniques are effective, they are unlikely to substantially impact the population's mortality from esophageal cancer; better methods are needed to identify at risk patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / mortality*
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / diagnosis
  • Barrett Esophagus / mortality*
  • Cohort Studies
  • Endoscopy, Digestive System
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / mortality*
  • Female
  • Health Maintenance Organizations / statistics & numerical data
  • Humans
  • Male
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Registries / statistics & numerical data
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / mortality*
  • Survival Rate