HOME
Return to Table of Contents
160 EFFECTIVENESS OF BARRETT'S ESOPHAGUS SURVEILLANCE IN THE DETECTION OF ESOPHAGEAL ADENOCARCINOMA AND HIGH GRADE DYSPLASIA JHS Yeung, R McLean, CKW Wong BACKGROUND AND AIM: The incidence of esophageal adenocarcinoma (EA) has been growing faster than that of any other cancer since the 1970s. Endoscopic surveillance is recommended for all patients with Barrett's Esophagus (BE), the most important risk factor for development of EA. Recent studies have shown that EA detected through surveillance of BE are associated with lower disease staging and improved survival. Unfortunately, it appears that most EAs are still diagnosed by symptoms. Our aim was to evaluate the effectiveness of BE surveillance at detecting EAs in our region.
Division of Gastroenterology, Department of Medicine and Department of Pathology, University of Alberta, Edmonton, Alberta
METHODS: We analyzed all patients who had been diagnosed with either high grade dysplasia (HGD) or adenocarcinoma of the gastroesophageal junction (GEJ) or esophagus in our health region between 2001 and 2006. Cases where esophageal cancer was a result of caustic ingestion, a recurrent cancer, or secondary to metastatic spread were excluded. As well, patients with gastric cardia adenocarcinoma, squamous cell carcinoma, lymphomas, leiomyosarcomas, or benign tumours were also excluded. Patients were further stratified as either being diagnosed through a BE-surveillance program, or through endoscopy as a result of investigating presenting symptoms. Data that was obtained include presence, frequency and duration of dysphagia, hemoptysis, as well as heartburn. A history of BE and all screening endoscopies performed prior to the cancer diagnosis were also recorded.
RESULTS: We identified 227 patients with HGD or esophageal adenocarcinoma. In this cohort, there were 26 females and 201 males with an average age of 64.9 years. Twenty of the 227 patients (8.8%) were detected to have HGD or adenocarcinoma through BE surveillance. Patients with HGD were also more likely to be detected through surveillance (47.9%) than patients with adenocarcinoma (4.4%).
CONCLUSIONS: BE surveillance detected 8.8% of the total number of HGD and esophageal adenocarcinoma cases diagnosed in our 5 year review. Surveillance of known BE was effective at detecting HGD. However, a large majority of patients with EA or HGD are still diagnosed via presenting symptoms. Additional studies need to evaluate whether surveillance's ability to detect low-stage disease affects the patient's survival rate.