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Does a surgical antireflux procedure decrease the incidence of esophageal adenocarcinoma in Barrett's esophagus? A
Kathleen E Corey1, Sarah M Schmitz, Nicholas J Shaheen
1Center for Esophageal Diseases and Swallowing, the Division of Digestive Diseases, and the School of Public Health, University of North Carolina at, North Carolina, Chapel Hill 27599-7080, USA.
The American Journal of Gastroenterology
|November 26, 2003
Summary
Surgical antireflux procedures do not significantly decrease the risk of esophageal adenocarcinoma in patients with Barrett's esophagus (BE). The cancer risk in BE patients is low, and surgery is not recommended as a cancer-preventing measure.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Epidemiology
Background:
- Barrett's esophagus (BE) is a known risk factor for esophageal adenocarcinoma.
- The efficacy of surgical antireflux procedures (SARP) in reducing cancer risk in BE patients remains uncertain.
Purpose of the Study:
- To compare the incidence of esophageal adenocarcinoma in BE patients who underwent SARP versus those managed medically.
- To determine if SARP can decrease cancer risk in the context of BE.
Main Methods:
- A meta-analysis of English language literature from 1966 to October 2001 was conducted using MEDLINE.
- Studies were included if they reported cancer risk per patient-year, had histological confirmation of BE and adenocarcinoma, and described medical vs. SARP intervention.
- Multivariable regression controlled for patient age, country of origin, and BE length.
Main Results:
- Out of 1247 abstracts reviewed, 34 met inclusion criteria, totaling 4678 patient-years (SARP) and 4906 patient-years (medical).
- Cancer incidence was 3.8/1000 patient-years for SARP versus 5.3/1000 patient-years for medical management (p=0.29).
- No significant difference in cancer rates was observed between groups, even in recent studies or after multivariable analysis.
Conclusions:
- The incidence of esophageal adenocarcinoma in BE patients is low.
- Surgical antireflux procedures do not significantly reduce this risk.
- SARP should not be recommended as an antineoplastic strategy for BE.