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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
5 days ago

Dr Michael Lim, a senior consultant at the Paediatric Pulmonary and Sleep Division, National University Hospital, Singapore, speaks to Roshini Claire Anthony on the rare disease that is cystic fibrosis.

3 days ago
Susceptibility‐guided therapy is as effective as empiric modified bismuth quadruple therapy for the first-line treatment of Helicobacter pylori infection, with both yielding excellent eradication rates, as shown in a recent trial.
5 days ago
It appears that long-term consumption of fish and omega-3 fatty acid does not influence the risk of incident hypertension in middle-aged and older men, suggests a US study.
3 days ago
The risk factors and outcomes associated with an increased risk of permanent pacing include atrial fibrillation (AF) ablation, multivalve surgery and New York Heart Association (NYHA) functional class III/IV, a recent study has found.