The Annual Risk of Esophageal Adenocarcinoma Does Not Decrease Over Time in Patients With Barrett's Esophagus

Area of Science:

• Gastroenterology
• Oncology
• Medical Surveillance

Background:

• Barrett's esophagus (BE) necessitates endoscopic surveillance to detect esophageal adenocarcinoma (EAC).
• The optimal duration and frequency of surveillance for BE patients remain debated.
• Investigating EAC risk factors related to surveillance patterns is essential for clinical practice.

Purpose of the Study:

• To evaluate the association between endoscopic surveillance intensity and EAC risk in BE patients.
• To determine if the number of endoscopies, duration of follow-up, or diagnosis year influences EAC incidence.
• To inform guidelines on long-term endoscopic surveillance for BE.

Main Methods:

• Retrospective cohort study of male veterans diagnosed with BE (2004-2009).
• EAC verification through structured electronic medical record reviews.
• Poisson regression analysis to calculate incidence rates and rate ratios (RR) for EAC based on surveillance parameters.

Main Results:

• EAC incidence increased with each additional endoscopy after a negative result (RR per endoscopy: 1.43).
• The 5th follow-up endoscopy showed a ninefold higher EAC incidence compared to the 1st (aRR: 8.82).
• EAC rates increased in years 5+ post-diagnosis compared to year 2 (aRR: 1.49), with no calendar year effect.

Conclusions:

• Persistent non-neoplastic BE did not correlate with reduced EAC risk.
• Findings support continued endoscopic surveillance in BE patients, even after multiple negative endoscopies.
• Surveillance intensity and duration are critical factors in managing EAC risk in BE.