Risk of oesophageal adenocarcinoma in individuals with Barrett's oesophagus

Holmberg, Dag; Ness-Jensen, Eivind; Mattsson, Fredrik; El–Serag, Hashem B.; Lagergren, Jesper

doi:10.1016/j.ejca.2016.12.037

Cited by 17 publications

(13 citation statements)

References 34 publications

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“…There has therefore been a concerted effort over several decades to identify and monitor patients with BE characterized by intestinal metaplasia1. However, the overwhelming majority of patients who develop EAC present de novo 2 and therefore do not benefit from endoscopic surveillance programs3–5. Research efforts have therefore focused on finding easily identifiable factors that might select an at risk group for more systematic screening 6–10.…”

Section: Introductionmentioning

confidence: 99%

Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts

Sawas

Killcoyne²,

Iyer

et al. 2018

Gastroenterology

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Section: Introductionmentioning

confidence: 99%

Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts

Sawas

Killcoyne²,

Iyer

et al. 2018

Gastroenterology

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“…An outcome less than three months after index BO could be part of the diagnostic work-up instead of 'missed' and therefore these patients were excluded from the analysis (n ¼ 187). 13,16 Incident HGD/OAC was defined as being diagnosed at least one year after index BO biopsy. Follow-up was defined from the first BO diagnosis until first HGD or OAC diagnosis and was available until 31 December 2013.…”

Section: Discussionmentioning

confidence: 99%

“…However, HGD/OAC patients diagnosed less than three months after BO may be part of the diagnostic work-up. 16 Chadwick et al also excluded patients diagnosed within three months after a BO diagnosis for the calculation of their 'missed' rate. 13 They found that 7.8% of the patients with OAC underwent a previous endoscopy three to 36 months preceding diagnosis of OAC, which is similar to the 'missed' rate of 9% detected in non-dysplastic BO patients in the present study.…”

Section: Discussionmentioning

confidence: 99%

‘Missed’ oesophageal adenocarcinoma and high‐grade dysplasia in Barrett's oesophagus patients: A large population‐based study

Putten

Johnston²,

Murray

et al. 2018

UEG Journal

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“…Clinical guidelines recommend endoscopy surveillance at given intervals or endoscopic eradication therapy for patients with LGD or HGD without focal lesions [3,4], and endoscopic surveillance of Barrett's esophagus prevents mortality in esophageal adenocarcinoma [5]. Non-dysplastic Barrett's may be monitored at longer intervals because the absolute risk of esophageal adenocarcinoma is low in these patients [6,7]. Adherence to guidelines for non-dysplastic Barrett's esophagus have been reported to be poor, but no study has evaluated how well the guidelines specifically for dysplastic Barrett's esophagus are followed in clinical practice, where the cancer risk is substantially higher than for non-dysplastic Barrett's esophagus.…”

Section: Introductionmentioning

confidence: 99%

Adherence to clinical guidelines for Barrett’s esophagus

Holmberg

Ness-Jensen

Mattsson

et al. 2019

Scandinavian Journal of Gastroenterology

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Background and aim: Clinical guidelines recommend endoscopy surveillance at given intervals or endoscopic therapy for Barrett's esophagus with low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Whether these guidelines are followed in clinical practice is unknown and was assessed in this study. Methods: This nationwide Swedish cohort study included patients with Barrett's esophagus with histologically verified LGD or HGD from 50 centers in 2006-2013. These patients were followed up using nationwide registers. Adherence to clinical guidelines was explored. Eight potential risk factors for deviation from guidelines were assessed using multivariable logistic regression, providing adjusted odds ratios (OR) with 95% confidence intervals (95%CI). Results: Among 211 patients with Barrett's esophagus (mean age 67.0 years, standard deviation 9.7 years, 81% male), 71% had LGD and 29% had HGD. During median 3.9 years of follow-up, 84% underwent a follow-up endoscopy, 17% received endoscopic therapy and 8% underwent esophagectomy. The clinical management deviated from guidelines in 60% of all patients (69% in LGD and 39% in HGD), which was mainly due to under-surveillance (86%). Risk factors for deviation from guidelines were LGD compared to HGD (OR 3.4, 95%CI 1.7-6.8), longer Barrett's segment length (OR 2.0, 95%CI 1.0-3.9, comparing 3 cm with <3 cm), and treatment at gastroenterology compared to surgery departments (OR 2.3,. Age, sex, calendar period and university hospital status were not associated with deviation from surveillance guidelines. Conclusions: Adherence to guidelines for dysplastic Barrett's esophagus is poor, particularly for LGD. Efforts to implement clinical guideline recommendations are needed. ARTICLE HISTORY

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Risk of oesophageal adenocarcinoma in individuals with Barrett's oesophagus

Cited by 17 publications

References 34 publications

Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts

Identification of Prognostic Phenotypes of Esophageal Adenocarcinoma in 2 Independent Cohorts

‘Missed’ oesophageal adenocarcinoma and high‐grade dysplasia in Barrett's oesophagus patients: A large population‐based study

Adherence to clinical guidelines for Barrett’s esophagus

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