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Endoscopic surveillance improves detection of, survival in oesophageal adenocarcinoma

05 Jun 2018

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.

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Most Read Articles
Stephen Padilla, 21 hours ago
Treatment with oral thrombopoietin receptor agonist eltrombopag leads to similar platelet counts in patients with chronic immune thrombocytopaenia (cITP) and persistent (per)ITP, according to the results of phase III (EXTEND) and IV studies presented at the 23rd Congress of the European Hematology Association (EHA 2018) held in Stockholm, Sweden.
Pearl Toh, 3 days ago
Lonely people were twice as likely to die from any cause than people who did not feel lonely, according to a study based on a national survey presented at the recent EuroHeartCare 2018 in Dublin, Ireland. Also, loneliness is associated with poorer patient-reported outcomes in terms of mental and physical health in patients with heart disease.
6 days ago
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6 days ago
Use of quetiapine among critically ill patients rarely leads to corrected QT (QTc) interval prolongation, reports a new study.