Endoscopic surveillance improves detection of, survival in oesophageal adenocarcinoma
Active endoscopic surveillance in patients with Barrett’s oesophagus (BE) promotes detection of earlier-stage oesophageal adenocarcinoma (EAC) and may result in a small survival benefit, according to a recent meta-analysis.
Pooled analysis of four cohort studies showed that regular vs no/incomplete surveillance was associated with significantly lower EAC-related mortality (risk ratio [RR], 0.60; 95 percent CI, 0.50–0.71; p<0.00001). No significant heterogeneity was detected, but adjustment for disease stage and treatment attenuated the effect of surveillance (hazard ratio [HR], 0.72; 0.51–1.01).
Regular surveillance also led to significantly decreased all-cause mortality (HR, 0.75; 0.59–0.94). Minimal heterogeneity in the data was observed.
A subsequent analysis of studies grouped according to prior BE diagnosis confirmed these findings. Those with BE histories had significantly lower risks of EAC-related mortality (RR, 0.73; 0.57–0.94; p=0.02) and all-cause mortality (OR, 0.59; 0.45–0.76; p<0.0001).
In addition, patients who received regular surveillance were significantly more likely to be diagnosed with early-stage cancer (stage 0 or I) than those who received inadequate or no surveillance (RR, 2.11; 1.08–4.11).
In contrast, regular surveillance did not appear to have a significant impact on intervention, as both patient groups who received and did not receive active surveillance showed the same likelihoods of oesophagectomy (RR, 1.47; 0.92–2.33).
Accessing the databases of Medline, Cochrane CENTRAL, Web of Science, PubMed, Scopus and Ovid Embase, researchers identified prospective or retrospective studies focused on the effects of endoscopic surveillance of EAC-related outcomes.