INCIDENCE OF BARRETTS-ADENOCARCINOMA IN AN ITALIAN POPULATION - AN ENDOSCOPIC SURVEILLANCE PROGRAM

Background: Barrett's oesophagus is a premalignant condition leading t o adenocarcinoma. The incidence of adenocarcinoma of the oesophagus an d the gastrooesophageal junction is rapidly increasing in the USA, nor thern and central Europe. Data from southern Europe are still unavaila ble. Objective: To evaluate the incidence of oesophageal adenocarcinom a in a large cohort of Italian patients with Barrett's oesophagus. Met hods: A total of 344 patients (253 males and 91 females, age range 19- 75 years) with histologically proven Barrett's oesophagus (length of m etaplasia greater than or equal to 3 cm) were enrolled from November 1 987 to June 1995. Endoscopic and histological examinations were schedu led at yearly intervals. Results: One hundred and eighty-seven patient s complied with the follow-up. The mean duration of the follow-up peri od was 36 months (total follow-up 562 patient-years; range 12-90 month s). Low grade dysplasia was found in five patients at the initial exam ination. During the surveillance period, dysplasia increased in freque ncy as well as in severity and was found exclusively in the intestinal type of Barrett's oesophagus. In all, dysplastic changes were found i n seven patients (five low grade and two high grade) and adenocarcinom a developed in three patients during the follow-up. In a single case, both adenocarcinoma and specialized columnar epithelium developed with out any evidence of dysplasia or intestinal metaplasia at the previous follow-up examination. This prospective study shows an incidence of a denocarcinoma in Barrett's oesophagus of 1/187 patient years. When onl y patients with specialized columnar epithelium were considered, the r isk of adenocarcinoma was 1/88 patient-years. Conclusion: The present report shows that the incidence of adenocarcinoma in Italian Barrett's oesophagus patients is in the range of that reported from other Weste rn countries.