Incidence of adenocarcinoma and mortality in patients with Barrett's oesophagus diagnosed between 1976 and 1986: implications for endoscopic surveillance

The objective of this study was to investigate the incidence of oesophageal adenocarcinoma and its contribution to mortality in patients with Barrett' s oesophagus, and to identify a subgroup of patients who may benefit from e ndoscopic surveillance. This was a retrospective study of a cohort of 70 patients diagnosed in the endoscopy unit of a Scottish teaching hospital as having Barrett's oesophag us between 1976 and 1986. Information was obtained from case notes, endosco py records, histology reports and death certificates. Patients were include d if they had: (a) columnar-lined oesophagus of at least 3 cm; (b) histolog ical confirmation; and (c) absence of cancer when endoscopically diagnosed as having Barrett's oesophagus. The main outcome for the patients was devel opment of adenocarcinoma or death. Information was available for 59 of 70 p atients (84%). Forty-four patients were confirmed to have Barrett's oesopha gus and were followed up for 418 patient-years. Only two patients developed oesophageal adenocarcinoma, resulting in an incidence of one case in 209 p atient-years, a 55-fold risk compared with age- and sex-matched population in Scotland. Both these patients had intestinal metaplasia and Barrett's ul cer. The majority (90%) of patients died as a result of causes unrelated to adenocarcinoma of oesophagus. In patients under 70 years with intestinal m etaplasia, 189 annual endoscopies would have been required to detect one ca ncer. Adenocarcinoma is an uncommon cause of mortality in patients with Barrett's oesophagus. Endoscopic surveillance is unlikely to alter overall mortality in patients with Barrett's oesophagus. However, by limiting endoscopic sur veillance to patients under 70 years with intestinal metaplasia, the estima ted cost per cancer detected can be reduced to pound 23 000.