Original article
Clinical endoscopy
Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis

https://doi.org/10.1016/j.gie.2007.07.019Get rights and content

Background

Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) are at a high risk for developing esophageal adenocarcinoma. However, the reported rate of cancer development in patients with HGD who were undergoing surveillance has varied among published studies.

Objective

To determine an overall precise estimate of cancer incidence in patients with HGD who were undergoing surveillance endoscopy.

Design

Systematic review and meta-analysis.

Methods

We conducted a systematic search of the published literature and selected original articles that examined patients with histologically proven BE and HGD, patients who had not undergone endoscopic ablation or surgical therapy, patients with 6 months' follow-up, no esophageal cancer at the time of enrollment or within 6 months, and studies in which follow-up was reported in person-time. Two investigators independently conducted the search and abstraction.

Main Outcome Measurement

The weighted mean event rate was calculated and expressed as the weighted incidence rate, and its CIs were calculated.

Results

The search yielded 4 articles that met the inclusion criteria, and these were analyzed. A total of 236 patients with HGD were followed for 1241 patient-years, and esophageal adenocarcinoma was reported in 69 patients, providing a crude incidence rate of 5.57 per 100 patient-years. The weighted incidence rate was 6.58 per 100 patient-years (95% CI, 4.97-8.19).

Limitations

A small number of studies that met inclusion criteria.

Conclusions

In patients with BE and with HGD who were undergoing surveillance, esophageal adenocarcinoma develops in approximately 6 per 100 patient-years during the first few years of follow-up. These data may better inform physicians and patients in management decisions.

Section snippets

Search criteria

Studies were systematically searched independently by 2 investigators in MEDLINE (1966 to January 2006), PubMed, Ovid journals, the Database of Abstracts of Reviews of Effect, ACP Journal Club, the Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, old MEDLINE, MEDLINE Nonindexed Citations, BIOSIS Previews, the Food and Drug Administration database, and Cochrane Control Trial Registry. The key words used to search were Barrett's esophagus, BE, high

Search findings

Our initial search yielded 3843 citations. Of these, 196 articles were relevant, and these were retrieved and reviewed. Finally, 4 of 196 articles were selected, because they met all the inclusion and exclusion criteria. The rest were excluded because they did not meet the inclusion criteria. There was complete agreement between the investigators on selection of these studies.

Study characteristics

Three of the studies were conducted in a single center,19, 20, 21 and 1 was a multicenter study by Overholt et al.22 The

Discussion

Despite the lack of high-level evidence for a survival advantage, endoscopic screening of patients with long-standing reflux and surveillance of patients with BE have been proposed.23, 24 With increasing numbers of screening upper endoscopies being performed, there has been a rise in the detection and recognition of BE as well as HGD.14 Circumstantial evidence indicates the sequential histologic alteration from BE with no dysplasia to low-grade dysplasia followed by HGD and finally

Acknowledgment

This study was supported by the Veterans' Affairs Medical Center, Kansas City, Missouri.

References (31)

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