Original ResearchFull Report: Clinical—Alimentary TractImpact of Endoscopic Surveillance on Mortality From Barrett's Esophagus–Associated Esophageal Adenocarcinomas
Section snippets
Source Population and Data Sources
The underlying study population was all adult (≥18 y) members of Kaiser Permanente, Northern California (KPNC) during the years 1995–2009. KPNC is an integrated health care delivery system with approximately 3.3 million current members who are approximately representative of the age, sex, and ethnic distributions of the underlying regional population.21 Patients with Barrett’s esophagus receive surveillance examinations through physician-directed recommendations.
Barrett’s Esophagus
Persons with Barrett’s esophagus
Results
We identified 8272 patients with a Barrett’s esophagus diagnosis using electronic coding (Figure 1), 351 of whom simultaneously or subsequently were diagnosed with an esophageal or gastroesophageal junction adenocarcinoma. Of these 351, 70 had their cancer diagnosed 6 months or more after their Barrett’s esophagus diagnosis, and 51 died during follow-up evaluation. Manual review excluded 13 patients: 5 patients whose cause of death could not be determined, 2 with deaths from other cancers, 3
Discussion
Surveillance for persons at high risk of a disease offers the potential to detect preclinical disease amenable to early treatment. To provide this benefit, the surveillance method must fulfill certain criteria.20 First, the test must be able to detect a condition before it would present with symptoms. Second, treatment of this preclinical condition should yield a superior outcome to treatment of disease detected because of symptoms. Third, it should be feasible, available, and economically
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This article has an accompanying continuing medical education activity on page e14. Learning Objective: Upon completion of these questions, successful learners will be able to assess the evidence supporting routine endoscopic surveillance of patients with Barrett's esophagus.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by US National Institutes of Health grant RO1 DK63616; the Kaiser Permanente Research Project on Genes, Environment and Health; and a Kaiser Permanente Community Benefits Grant.