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ENDOSCOPIC SURVEILLANCE IN AN EXPERT BARRETT’S CENTRE ASSOCIATES WITH HIGH DETECTION OF EARLY NEOPLASIA AND LOW DISEASE-SPECIFIC MORTALITY

Judith Honing 1, Victor Lu 1, W. Keith Tan 1, Shriya Vishwanathan 1, Calvin Cheah 1, Rebecca Fitzgerald 1, Massimiliano di Pietro 1

Affiliations

1 University of Cambridge, Cambridge, United Kingdom

Summary

AI Generated

Prospective single-centre study of 980 Barrett's esophagus patients in an expert surveillance programme found an annual progression rate to high-grade dysplasia or cancer of 1.98%, with 79.6% of cancers detected at stage I and disease-specific mortality of 0.4%.

In the expert cohort followed for median 5.7 years, 111 of 980 patients progressed to high-grade dysplasia or esophageal adenocarcinoma, yielding an annual progression rate of 1.98%.
Of 49 patients diagnosed with esophageal adenocarcinoma in the expert cohort, 39 (79.6%) were stage I, and only 4 patients (0.4%) experienced disease-specific mortality in intention-to-treat analysis.
A comparison non-expert cohort of 98 patients followed for median 4.1 years had an annual progression rate of 0.50%, no high-grade dysplasia or stage I cancers detected, and 2% disease-specific mortality with two stage IV cancer diagnoses.
The expert centre featured endoscopists trained in Barrett's surveillance standards and image-enhanced endoscopy, centralised pathology review, and a tracking system to reduce loss to follow-up.
The authors conclude that randomised-controlled trials are warranted to compare surveillance outcomes across different clinical settings.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Specialist guidelines recommend endoscopic surveillance for Barrett’s esophagus (BE) to reduce mortality related to esophageal adenocarcinoma (EAC), but the setting for optimal BE monitoring is unclear. Previous prospective BE surveillance studies showed rates of neoplastic progression between 0.78% and 1.2% (1-3).

Aims & Methods

We aimed to assess progression rate and disease-specific mortality in a large cohort of patients followed up in a single BE expert centre. Prospective longitudinal single centre study. The expert centre consisted of a dedicated BE service comprising endoscopists trained in BE surveillance standards and image-enhanced endoscopy, a centralised pathology review and a tracking system to reduce lost to follow up. We recruited patients referred for surveillance of BE. We excluded patients with single surveillance endoscopy, high-grade dysplasia (HGD) or OAC at or within 12 months from index endoscopy; no intestinal metaplasia (IM) or BE<1cm; <12 months follow-up. The primary outcome was progression to HGD/EAC. Secondary outcome measures included cancer stage and disease specific mortality (intention-to-treat analysis). Outcomes were compared with a cohort patients surveyed by non-expert endoscopists at the primary institution (non-expert cohort).

Results

A total of 1,929 patients referred to the BE service were prospectively recruited to the study between 2004 to 2022, of which 949 were excluded due to HGD/EAC at index endoscopy (n=492), BE <1cm or no IM (n=246), single endoscopy or follow up shorter than 12 months (n=157), miscellaneous reasons (n=54). Finally, 980 BE patients met the inclusion criteria (expert cohort) and were followed up for a median of 5.7 years. Of these, 869 had at most low-grade dysplasia at last follow-up and 111 developed HGD or OAC during the study period (progressors), which equalled to an annual progression rate of 1.98%. Overall, 49 patients received a OAC diagnosis, of which 39 (79.6%) had stage I, 5 (10.2%) had stage II, 3 (6.1%) had stage III, 2 (4.1%) had stage IV. In an intention-to-treat analysis, only 4 patients (0.4%) had disease-specific mortality, of which one declined surveillance and one was discharged as unfit for monitoring. In the non-expert cohort, we identified 213 patients from hospital records, of which 98 met the inclusion criteria and were followed up for a median of 4.1 years. The annual progression rate was 0,50%, with no HGD or stage I EAC diagnoses. Two patients were diagnosed with stage IV EAC and had disease specific mortality (2%).

Conclusion

Endoscopic surveillance in an expert BE centre leads to a high rate of early BE neoplasia detection and a low rate of disease specific mortality. Randomised-controlled trials are warranted to compare outcomes of surveillance in different clinical setting.

References

Development and Validation of a Model to Determine Risk of Progression of Barrett's Esophagus to Neoplasia. Parasa et al. Gastroenterology 2018, Apr;154(5):1282-1289
Barrett's esophagus surveillance in a prospective Dutch multi‐center community‐based cohort of 985 patients demonstrates low risk of neoplastic progression. Klaver et al United European Gastroenterol J 2021 Oct;9(8):929-937
Impact of surveillance for Barrett’s oesophagus on tumour stage and survival of patients with neoplastic progression. Kastelein et al. Gut 2016, Apr;65(4):548-54

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Upper GI endoscopy and neoplasia (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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