Surveillance of Nondysplastic Barrett Esophagus Is Not Supportable

David A. Johnson, MD

The latest observational study showed no mortality benefit. It's time to question this practice.

Despite routine recommendation of endoscopic surveillance in patients with Barrett esophagus (BE), few studies have documented its benefit in reducing dysplasia or cancer. Observational studies suggest that endoscopic surveillance might detect curable dysplasia in BE and might allow for discovery of less advanced cancers than those found in symptomatic patients. In the current case-control study, researchers assessed whether endoscopic surveillance in patients with BE was associated with reduced cancer mortality.

In a population of 8272 health care plan members who had been diagnosed with BE, investigators identified 38 case patients who died from esophageal adenocarcinoma and had received a diagnosis of BE at least 6 months prior to cancer diagnosis.

Surveillance within 3 years was not associated with a decreased risk for death from esophageal adenocarcinoma (odds ratio, 0.99; 95% confidence interval, 0.36–2.75). Mortality did not differ by surveillance status. Although BE length ≥3 cm and prior dysplasia were each associated with increased risk for mortality, adjustment for these factors did not change the main findings.

Citation(s):

Corley DA et al. Impact of endoscopic surveillance on mortality from Barrett's esophagus–associated esophageal adenocarcinomas. Gastroenterology 2013 Aug; 145:312.