Incidence of adenocarcinoma among patients with Barrett's esophagus

January 01, 0001

Incidence of adenocarcinoma among patients with Barrett's esophagus

Accurate population-based data are needed on the incidence of esophageal adenocarcinoma and high-grade dysplasia among patients with Barrett's esophagus. These Danish authors conducted a nationwide, population- based, cohort study involving all patients with Barrett's esophagus in Denmark during the period from 1992 through 2009, using data from the Danish Pathology Registry and the Danish Cancer Registry. They determined the incidence rates (numbers of cases per 1000 person-years) of adenocarcinoma and high-grade dysplasia. As a measure of relative risk, standardized incidence ratios were calculated with the use of national cancer rates in Denmark during the study period.

They found: "We identified 11,028 patients with Barrett's esophagus and analyzed their data for a median of 5.2 years. Within the first year after the index endoscopy, 131 new cases of adenocarcinoma were diagnosed. During subsequent years, 66 new adenocarcinomas were detected, yielding an incidence rate for adenocarcinoma of 1.2 cases per 1000 person-years. As compared with the risk in the general population, the relative risk of adenocarcinoma among patients with Barrett's esophagus was 11.3. The annual risk of esophageal adenocarcinoma was 0.12%. Detection of low-grade dysplasia on the index endoscopy was associated with an incidence rate for adenocarcinoma of 5.1 cases per 1000 person-years. In contrast, the incidence rate among patients without dysplasia was 1.0 case per 1000 person-years. Risk estimates for patients with high-grade dysplasia were slightly higher."

The authors concluded: "Barrett's esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of 0.5%, which is the basis for current surveillance guidelines. Data from the current study call into question the rationale for ongoing surveillance in patients who have Barrett's esophagus without dysplasia."

Guidelines for surveillance of Barrett’s esophagus should be reconsidered in light of these findings.

For the full abstract, click here.

N Engl J Med 365:1375-1383, 13 October 2011 © 2011 to the Massachusetts Medical Society
Incidence of Adenocarcinoma among Patients with Barrett's Esophagus. Frederik Hvid-Jensen, Lars Pedersen, Asbjørn Mohr Drewes, Henrik Toft Sørensen, and Peter Funch-Jensen. Correspondence to Dr. Hvid-Jensen: funchjensen@gmail.com

Category: D. Digestive. Keywords: Barrett’s esophagus, adenocarcinoma, dysplasia, surveillance, population-based cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 25 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.