Skip to main content
SpringerLink
Log in

Rigorous Surveillance Protocol Increases Detection of Curable Cancers Associated with Barrett's Esophagus

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Esophageal adenocarcinoma is increasing in incidence and has a high mortality unless detected early. Barrett's esophagus is the only known risk factor for this cancer; however, whether endoscopic surveillance reduces morbidity and mortality is controversial. Endoscopic cancer surveillance programes for Barrett's esophagus are not routinely practiced in the UK, and this is the first study to examine whether a rigorous surveillance protocol increases the detection rate of early oesophageal cancer. All patients with a diagnosis of Barrett's esophagus or associated adenocarcinoma attending Havering Hospitals NHS Trust between 1992 and 1998 were included. A retrospective analysis was made of patients undergoing informal surveillance (96 patients, 1992–1997) and a prospective analysis was conducted following the implementation of a rigorous protocol (108 patients, 1997–1998). Over the same time periods Barrett's associated cancers diagnosed in patients not undergoing surveillance were analyzed (262 patients 1992–1997, 98 patients 1997–1998). From 1992 to 1997, one case of high-grade dysplasia was detected (N = 96, 1%). From 1997 to 1998, two cancers and three high-grade dysplasias were detected during rigorous surveillance (N = 108, 4.6%). Three of these patients have had curative esophagectomies (one high-grade dysplasia and two T1,N0,M0 tumors). In 1992–1997, 10 patients were found to have cancer in previously undiagnosed Barrett's esophagus (N = 262, 3.8%). Of 3/10 cancers treated surgically, one patient had a curative procedure (T1,N0,M0). In 1997–1998, nine patients were found to have de novo Barrett's esophagus cancer (N = 88, 10.2%) and three had curative resections (T1,N0,M0). Two of the patients with T1 lesions had no endoscopic evidence of cancer but were detected as a result of the multiple biopsy protocol. In conclusion, a rigorous biopsy protocol increases the detection of early cancer in Barrett's esophagus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Blot W, Devesa S, Fraumeni J: Continued climb in rates of esophageal adenocarcinoma: An update. JAMA 270:1320, 1993

    Google Scholar 

  2. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zermeister AR: Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 104:510–513, 1993

    Google Scholar 

  3. Devesa S, Blot W, Fraumeni J Jr: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 15:2049–2053, 1998

    Google Scholar 

  4. Landis S, Murray T, Bolden S, Wingo P: Cancer Statistics. CA Cancer J Clin 48:6–29, 1998

    Google Scholar 

  5. Lund O, Kimose H, Augaard M, Hasenkam J, Erlanden M: Risk stratification and long-term results for carcinoma of the esophagus. J Thorac Cardiovas Surg 99:200–209, 1990

    Google Scholar 

  6. Misiewicz J, Pounder R, Venables C: Carcinoma of the Oesophagus. Diseases of the Gut and Pancreas, (Vol 1) Oxford, Blackwell Scientific Publications, 1994

    Google Scholar 

  7. Paraf F, Flejou J-F, Pignon J-P, Fekete F, Potet F: Surgical pathology of adenocarcinoma arising in Barrett' esophagus. Analysis of 67 cases. Am J Surg Pathol 19:183–191, 1995

    Google Scholar 

  8. Lerut T, Coosemans W, Raemdonck DV, Dillemas B, Lyn PD, Marnette J, Geboes K: Surgical treatment of Barrett' carcinoma: Correlation' between morphologic findings and prognosis. J Thorac Cardiovasc Surg 107:1059–1065, 1994

    Google Scholar 

  9. Korst R, Altorki N: Extent of resection and lymphadenopathy in early Barrett' cancer. Dis Esoph 10:172–178, 1997

    Google Scholar 

  10. Killinger W, Rice T, Goldblum J, et al: Stage 11 esophageal carcinoma; The significance of T and N. J Thorac Cardiovasc Surg 111:935–940, 1996

    Google Scholar 

  11. Spechler SJ, Goyal RJ: The columnar-lined esophagus, intestinal metaplasia and Norman Barrett. Gastroenterology 110:614–621, 1996

    Google Scholar 

  12. Clark G, Smyrk T, Burdiles P, Hoeft S, Peters J, Kiyabu M, Hinder R, Bremner C, DeMeester T: Is Barrett' metaplasia the source of adenocarcinomas of the cardia? Arch Surg 129:609–614, 1994

    Google Scholar 

  13. Winters C, Spurling T, Chobanian S, Curtis D, Esposito R, Johnson D, Cruess D, Coetligon J, Gurney M, et al: Barrett' esophagus: A prevalent occult complication of gastrooesophageal reflux disease. Gastroenterology 92:118–124, 1987

    Google Scholar 

  14. Stein HJ, Hoeft S, DeMeester TR: Reflux and motility patterns in Barrett' esophagus. Dis Esoph 5:21–28, 1992

    Google Scholar 

  15. Cameron A, Kamath P, Carpenter H: Prevalence of Barrett' esophagus and intestinal metaplasia at the esophagogastric junction. Gastroenterology 112:A82, 1997

    Google Scholar 

  16. Haggitt R: Barrett' esophagus, dysplasia and adenocarcinoma. Gastroenterol Clin North Am 20:817–834, 1994

    Google Scholar 

  17. Reid BJ: Barrett' esophagus and adenocarcinoma. Annu Rev Med 38:477–492, 1987

    Google Scholar 

  18. Drewitz D, Sampliner R, Garewal H: The incidence of adenocarcinoma in Barrett' esophagus: A prospective study of 170 patients followed 4.8 years. Am J Gastroenterol 92:212–215, 1997

    Google Scholar 

  19. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr: Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289, 1991

    Google Scholar 

  20. Tytgat G: Does endoscopic surveillance in esophageal columnar metaplasia have any real value? Endoscopy 27:19–26, 1995

    Google Scholar 

  21. Spechler S: Endoscopic surveillance for patients with Barrett' esophagus: Does the cancer risk justify the practice? Ann Intern Med 106:902–904, 1987

    Google Scholar 

  22. Provenzale D, Kemp J, Arora S, Wong J: A guide for surveillance of patients with Barrett' esophagus. Am J Gastroenterol 89:670–680, 1994

    Google Scholar 

  23. Smith A, Maxwell-Armstrong C, Welch N, Schofield J: Surveillance for Barrett' oesophagus. Br J Surg 86:276–280, 1999

    Google Scholar 

  24. Dent J, Bremner CG, Collen MJ, Haggitt RC, Spechler SC: Working party report to the World Congresses of Gastroenterology, Sydney 1990: Barrett' esophagus. J Gastroenterol Hepatol 6:1–22, 1990

    Google Scholar 

  25. Sampliner R, Gastroenterology. atPPCotACo: Practice guidelines on the diagnosis, surveillance, and therapy of Barrett' esophagus. Am J Gastroenterol 93:1028–1032, 1998

    Google Scholar 

  26. Fleming I, Cooper J, Henson D, et al (eds): AJCC Staging Manual, 5th ed Philadelphia, Lippincott-Raven, Publishers, 1997

    Google Scholar 

  27. Hermaneck, Sobin: In TNM Classification of Malignant Tumours International Union Against Cancer. Berlin, Springer-Verlag, 1987

    Google Scholar 

  28. Cameron AJ, Lomboy CT: Barrett' esophagus: Age, prevalence and extent of columnar epithelium. Gastroenterology 103:1241–1245, 1992

    Google Scholar 

  29. Macdonald C, Wicks A, Playford R: Ten years' experience of screening patients with Barrett' oesophagus in a university teaching hospital. Gut 41:303–307, 1997

    Google Scholar 

  30. Peters J, Clark G, Ireland A, Chandrasoma P, Smyrk T, De-Meester T: Outcome of adenocarcinoma arising in endoscopically surveyed and nonsurveyed patients. J Thorac Cardiovasc Surg 108:813–821, 1994

    Google Scholar 

  31. Cameron A, Zinsmeister A, Ballard D, Carney J: Prevalence of columnar-lined (Barrett') esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 99:1918–1922, 1990

    Google Scholar 

  32. Reid BJ, Weinstein WM, Lewin KJ, et al: Endoscopic biopsies diagnose high grade dysplasia or early operable adenocarcinoma without grossly recognizable neoplastic lesions. Gastroenterology 94:81–90, 1988

    Google Scholar 

  33. Achkar E, Carey W: The cost of surveillance for adenocarcinoma complicating Barrett' esophagus. Am J Gastroenterol 83:291–294, 1988

    Google Scholar 

  34. Wright T, Gray M, Morris A, Gilmore I, Ellis A, Smart H, Myskow M, Nash J, Donnelly R, Kingsnorth A: Cost effectiveness of detecting Barrett' cancer. Gut 39:574–579, 1996

    Google Scholar 

  35. Fitzgerald R, Triadafilopoulos G: Recent developments in the molecular characterization of Barrett' esophagus. Dig Dis 16:63–80, 1998

    Google Scholar 

  36. Levine DS, Rubin CE, Reid BJ, Haggitt R: Specialized metaplastic columnar epithelium in Barrett' esophagus: A comparative transmission electron microscopic study. Lab Invest 60:418–432, 1989

    Google Scholar 

  37. Kumble S, Omary MB, Fajardo LF, Triadafilopoulos G: Multifocal heterogeneity in villin and Ep-cam expression in Barrett' esophagus. Int J Cancer 66:48–54, 1996

    Google Scholar 

  38. Hameetman W, Tytgat GNJ, Houthoff HJ, Van de Tweel JG: Barrett' esophagus: Development of dysplasia and adenocarcinoma. Gastroenterology 96:1249–1256, 1989

    Google Scholar 

  39. Cameron A, Ott B, Payne W: The incidence of adenocarcinoma in columnar-lined (Barrett') esophagus. N Engl J Med 313:857–859, 1985

    Google Scholar 

  40. Reid BJ: Barrett' esophagus and esophageal adenocarcinoma. Gastroenterol Clin North Am 20:817–834, 1991

    Google Scholar 

  41. Schnell T, Sontag S, Chejfec G, et al: High grade dysplasia still is not an indication for surgery in patients with Barrett' esophagus: An update. Gastroenterology 114:AG1149, 1998

    Google Scholar 

  42. Streitz J, Ellis FH Jr, Tilden R, Erickson R: Endoscopic surveillance of Barrett' esophagus: A cost-effective comparison with mammographic surveillance for breast cancer. Am J Gastroenterol 93:911–915, 1998

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Havering Hospitals NHS Trust, Romford, Essex, RM7 OBE, UK

    Rebecca C. Fitzgerald, Ibtisan T. Saeed, David Khoo & W. Rodney Burnham

  2. Department of Adult and Paediatric Gastroenterology, St. Bartholomew's & The Royal London School of Medicine and Dentistry, Turner Street, Whitechapel, London, E1 2AD, UK

    Rebecca C. Fitzgerald, Michael J.G. Farthing & W. Rodney Burnham

Authors
  1. Rebecca C. Fitzgerald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ibtisan T. Saeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Khoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael J.G. Farthing
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Rodney Burnham
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fitzgerald, R.C., Saeed, I.T., Khoo, D. et al. Rigorous Surveillance Protocol Increases Detection of Curable Cancers Associated with Barrett's Esophagus. Dig Dis Sci 46, 1892–1898 (2001). https://doi.org/10.1023/A:1010678913481

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1010678913481

Search

Navigation