Low Yield of Surveillance Endoscopy in Severe Oesophagitis: A 1700-Patient Retrospective Cohort Study

Guidelines recommend re-evaluation of severe oesophagitis to detect occult malignancy and Barrett's oesophagus (BE), but the utility and resource implications of this practice are unclear.

To assess the diagnostic yield, predictors, and resource implications of surveillance endoscopy in patients with severe (LA Grade C/D) oesophagitis.

We conducted a retrospective cohort study of 1700 index cases of severe oesophagitis over 18.5 years. Surveillance outcomes were assessed using endoscopy and histology databases. Univariate and multivariate logit regressions were used to explore associations with malignancy, BE and surveillance.

Only 6 oesophageal cancers (0.35%) were diagnosed, 3 at index. Of 717 re-evaluated patients (42.2%), just one malignancy was detected on surveillance. BE was newly identified in 48 patients (6.7% of re-evaluations), with no occult dysplasia found. No malignancies were diagnosed in the 980 patients not re-evaluated. The total cost of surveillance was €580,215.

Routine endoscopic surveillance for LA Grade C/D oesophagitis had a low diagnostic yield and high cost. These findings suggest that current guideline recommendations may need revision in favour of risk-stratified follow-up to optimise healthcare resource use.