Barrett's surveillance is worthwhile and detects curable cancers. A prospective cohort study addressing cancer incidence, treatment outcome and survival

Eur J Gastroenterol Hepatol. 2005 Sep;17(9):943-50. doi: 10.1097/00042737-200509000-00010.

Abstract

Objectives: To establish whether Barrett's surveillance is worthwhile in terms of incident cancers and whether outcomes are favourable.

Methods: A prospective non-randomized single centre Barrett's surveillance programme commencing 1 January 1992 through 1 April 2001 (112 months). Oesophagectomy recommended for high-grade dysplasia or carcinoma.

Results: Of 23 725 patients, 506 were diagnosed as Barrett's oesophagus and 24 (5%) had carcinoma at diagnosis (prevalence cancers). One hundred and twenty-six patients had at least one surveillance endoscopy; 248 surveillance endoscopies were performed spanning 338 patient years. Thirteen surveillance (incidence) cancers were detected. In the prevalence cancer group 12 of the 24 patients underwent oesophagectomy. Lymph nodes showed evidence of metastases in 10 of the 12 resections. In the surveillance group 10 patients underwent oesophagectomy. Lymph nodes showed evidence of metastases in one of the 10 resections. One patient in the prevalence cancer group (4% of group; 8% of those operated) and seven patients in the surveillance cancer group (54% of group; 70% of those operated) remain disease-free more than 2 years post-oesophagectomy. The cost per cancer cured is 7546 pounds. One curable cancer was detected per 48 patient years of surveillance.

Conclusions: Few Barrett's surveillance studies have addressed treatment outcomes and survival. In our study 5% of Barrett's patients undergoing endoscopy have prevalent cancers. If surveillance is performed, 4% per year develop cancer and 2% per year are cured of their cancers. Most surveillance cancers are operable and of those undergoing surgery 70% are cured. Barrett's surveillance is cost-effective compared with other cancer screening or surveillance initiatives.

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / economics
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / diagnosis*
  • Disease Progression
  • England
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / economics
  • Esophageal Neoplasms / surgery
  • Esophagectomy
  • Esophagoscopy
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Mass Screening / economics
  • Mass Screening / methods
  • Middle Aged
  • Population Surveillance / methods*
  • Precancerous Conditions / diagnosis*
  • Prospective Studies
  • Survival Analysis
  • Treatment Outcome