Barrett's Oesophagus Surveillance Versus Endoscopy at Need Study (BOSS): A Randomized Controlled Trial

Area of Science:

• Gastroenterology
• Oncology
• Clinical Trials

Background:

• Barrett's esophagus (BE) is a known precursor to esophageal adenocarcinoma (EAC).
• Surveillance endoscopy is standard practice for detecting malignant progression in BE.
• The BOSS trial was the first randomized controlled trial to evaluate BE surveillance efficacy.

Purpose of the Study:

• To compare the effectiveness of 2-yearly surveillance endoscopy versus
• at-need
• endoscopy for patients with Barrett's esophagus.
• To assess the impact of surveillance on overall survival, cancer-specific survival, and EAC diagnosis.

Main Methods:

• The BOSS trial was a randomized controlled trial involving 3453 patients across 109 UK centers.
• Patients were randomized to either 2-yearly surveillance endoscopy or
• at-need
• endoscopy based on symptoms.
• Follow-up was for a minimum of 10 years, with overall survival as the primary outcome.

Main Results:

• No significant difference in overall survival (HR, 0.95; 95% CI, 0.82-1.10) or cancer-specific survival (HR, 1.01; 95% CI, 0.77-1.33) was observed between the surveillance and
• at-need
• groups.
• There were no significant differences in time to EAC diagnosis or cancer stage at diagnosis.
• Serious adverse events related to endoscopy were rare and similar in both groups (0.46% vs 0.41%).

Conclusions:

• Routine endoscopic surveillance for Barrett's esophagus does not improve overall or cancer-specific survival.
• "At-need" endoscopy, guided by symptoms, appears to be a safe alternative management strategy for low-risk BE patients.
• The findings challenge current surveillance guidelines and suggest a potential shift in clinical practice.