Life expectancy and cancer risk in patients with Barrett's esophagus: A prospective controlled investigation

BACKGROUND: It has been suggested that patients with Barrett's esophagus ha ve a substantially increased risk of esophageal and possibly extra-esophage al cancers. We compared the incidence of cancer and the survival rates of p atients with Barrett's esophagus with those observed in patients with achal asia, with Schatzki's ring, and in the general population. PATIENTS AND METHODS: From 1980 through 1994, 60 consecutive patients with newly diagnosed long-segment Barrett's esophagus without dysplasia were see n in a single gastroenterology consultation office and followed until the F all of 1999. Cancer incidence and survival rates were compared with age- an d sex-matched patients with symptomatic Schatzki's ring (n = 60) and achala sia (n = 60). Survival data were also compared with those of the German pop ulation. RESULTS: During a mean (tSD) observation period of 10 +/- 5 years, 2 patien ts with Barrett's esophagus (3%; 95% confidence interval [CI]: 0% to 11 %) developed esophageal cancer, and 9 (15%; 95% CI: 7% to 27%) developed extra -esophageal cancers, These data differed only slightly from those of patien ts with Schatzki's ring (esophageal cancer: n = 1, 2%; 95% CI: 0% to 9%; ex tra-esophageal cancers: n = 9, 15%; 95% CI: 7%-27%) and achalasia (no esoph ageal cancers, extra-esophageal cancers: n = 3, 5%; 95% CI: 1% to 4%). Esti mated 10-year survival was similar in patients with Barrett's esophagus (83 %), patients with symptomatic Schatzki's ring (80%), patients with achalasi a (87%), and in the general population (82%). CONCLUSIONS: The cancer risk in patients with Barrett's esophagus has been overestimated. If patients with nondysplastic epithelium are followed, the risk of esophageal cancer is about 1 per 300 patient-years. Am J Med. 2001; 111:33-37. (C) 2001 by Excerpta Medica, Inc.