Surveillance of Barrett's Columnar-Lined Esophagus

The benefits of endoscopic surveillance in patients with Barretts esophagus, a precursor of cancer in the esophagus, are unproven. There is little evidence yet to support recommendations for precise endoscopic intervals.

Researchers in the U.K. examined surveillance practice for columnar-lined esophagus in the U.K. and the impact of endoscopic intervals on detection of dysplastic disease.
The team studied 817 patients with columnar-lined esophagus, registered with the U.K. National Barrett's Esophagus registry and undergoing surveillance.

A large proportion of dysplastic disease, it should be noted is detected on specific surveillance endoscopies.

Shorter endoscopic intervals for surveillance of low-grade dysplasia are associated with an increased detection of high-grade dysplasia/adenocarcinoma. Regular Endoscopic surveillance of patients with columnar-lined esophagus may identify those with early adenocarcinoma.

This particular study calculated the frequency of Endoscopic intervals in the detection of dysplastic disease which was analyzed using a test of association. Factors affecting surveillance intervals were analyzed using multiple linear regression.

Using these techniques, the researchers diagnosed 95 percent of patients with low-grade dysplasia, 95 percent with high-grade dysplasia and 71 percent with adenocarcinoma on surveillance endoscopies.

Mean endoscopic surveillance intervals varied between the centers from one to two years for non-dysplastic columnar-lined esophagus, and up to one year for low- and high-grade dysplasia. When low-grade dysplasia was surveyed, however, significantly higher proportions of high-grade dysplasia/adenocarcinoma were detected at intervals of three months or less.

Shorter endoscopic intervals were significantly associated with more detection of the presence of esophageal strictures, ulcers, increasing patient age and higher grade of dysplasia surveyed.

European Journal of Gastroenterology & Hepatology; 2009: 21(6): 636-41

COMMENT:
So draw your own conclusions.The evidence is not yet in to make official recommendations regarding surveillance in GERD and in Barretts. But if you had this, which would you choose for yourself? Would you choose shorter or longer surveillance times—or none at all as advocated by some?


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* Tune in tomorrow for Esophageal Adenocarcinoma-the White Man’s Disease.

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