Surveillance of Barrett's esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study

Am J Gastroenterol. 2014 Aug;109(8):1215-22. doi: 10.1038/ajg.2014.156. Epub 2014 Jul 1.


Objectives: Barrett's esophagus (BE) is associated with an increased risk of developing esophageal adenocarcinoma (EAC). Patients with a known diagnosis of BE are usually advised to participate in an endoscopic surveillance program, but its clinical value is unproven. Our objective was to compare patients participating in a surveillance program for BE before EAC diagnosis with those not participating in such a program, and to determine predictive factors for mortality from EAC.

Methods: All patients diagnosed with EAC between 1999 and 2009 were identified in the nationwide Netherlands Cancer Registry. These data were linked to Pathologisch-Anatomisch Landelijk Geautomatiseerd Archief, the Dutch Pathology Registry. Prior surveillance was evaluated, and multivariable Cox proportional hazards regression analysis was performed to identify predictors for all-cause mortality at 2-year and 5-year follow-up.

Results: In total, 9,780 EAC patients were included. Of these, 791 (8%) patients were known with a prior diagnosis of BE, of which 452 (57%) patients participated in an adequate endoscopic surveillance program, 120 (15%) patients in an inadequate program, and 219 (28%) patients had a prior BE diagnosis without participating. Two-year (and five-year) mortality rates were lower in patients undergoing adequate surveillance (adjusted hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.64-0.92) when compared with patients with a prior BE diagnosis who were not participating. Other factors associated with lower mortality from EAC were lower tumor stage (stage I vs. IV, HR=0.19, 95% CI=0.16-0.23) and combining surgery with neoadjuvant chemo/radiotherapy (HR=0.66, 95% CI=0.58-0.76).

Conclusions: Participation in a surveillance program for BE, but only if adequately performed, reduces mortality from EAC. Nevertheless, it remains to be determined whether such a program is cost-effective, as more than 90% of all EAC patients were not known to have BE before diagnosis.

MeSH terms

  • Adenocarcinoma / mortality*
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / pathology*
  • Esophageal Neoplasms / mortality*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Population Surveillance
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / pathology*
  • Predictive Value of Tests
  • Registries
  • Risk Factors
  • Survival Rate

Supplementary concepts

  • Adenocarcinoma Of Esophagus