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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
4 days ago
Use of statin appears to reduce the risks of osteoporosis, hip fractures and vertebral fracture in patients newly diagnosed with a stroke, suggests a recent study.
07 Oct 2018
Patients using long-acting opioids with immunosuppressive properties are at greater risk of developing serious infections compared with those using the nonimmunosuppressive opioid counterpart, according to a study.
5 days ago
Monitoring of adverse events is lower in ambulatory patients on amiodarone than in those on dofetilide, a recent study has found. Improving the monitoring of such agents may help reduce the risk of morbidity in this population.
Yesterday
Rather than the presence or type or urinary incontinence, increasing severity of urinary incontinence correlates with increased depression, anxiety and stress among treatment-seeking women with lower urinary tract symptoms (LUTS), suggests a study.