Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans

Gastrointest Endosc. 2008 Nov;68(5):849-55. doi: 10.1016/j.gie.2008.02.062. Epub 2008 Jun 11.


Background: The efficacy of screening and surveillance EGD for esophageal adenocarcinoma (EAC) is controversial.

Objective: To examine the effect of an EGD before the diagnosis of EAC on survival after the diagnosis of cancer among patients with gastroesophageal reflux (GER).

Design: A retrospective, controlled cohort study.

Subjects: The national administrative databases of the Veterans Affairs were accessed, and patients diagnosed with EAC, from 1995 through 2003, who had a prior diagnosis consistent with GER were identified. Electronic medical records were then abstracted. Cases were subjects who had an EGD performed between 1 and 5 years before the diagnosis of EAC; controls were those subjects without a prior EGD.

Results: A total of 155 subjects with EAC and GER were identified. Cases with a history of an EGD at least 1 year before a diagnosis of EAC (n = 25) were diagnosed at earlier stages than those without a prior EGD (P = .02) but did not experience a significant improvement in survival (adjusted hazard ratio 0.93 [95% CI, 0.58-1.50]). Cases who had been enrolled in surveillance programs that adhered to published guidelines trended toward improved survival, but long-term survival reverted toward the rate found without any surveillance.

Conclusions: A prior EGD was associated with an improved stage at the diagnosis of EAC but did not alter long-term survival. In the absence of prospective, randomized, controlled trials, the benefit of screening and surveillance to decrease mortality from EAC cannot be confirmed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / etiology
  • Adenocarcinoma / mortality
  • Aged
  • Barrett Esophagus / complications
  • Barrett Esophagus / diagnosis
  • Endoscopy, Gastrointestinal*
  • Esophageal Neoplasms / diagnosis*
  • Esophageal Neoplasms / etiology
  • Esophageal Neoplasms / mortality
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis
  • Humans
  • Male
  • Survival Rate
  • United States
  • Veterans / statistics & numerical data