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Background and Aims

Identification of post-endoscopy esophageal adenocarcinoma (PEEC) among Barrett's esophagus (BE) patients presents an opportunity to improve survival of esophageal adenocarcinoma (EAC). We aimed to estimate the proportion of PEEC within the first year after BE diagnosis.

Methods

Multiple databases (Medline, Embase, Scopus and Cochrane databases) were searched until September 2020 for original studies with at least 1-year follow-up, which reported EAC and/or high-grade dysplasia (HGD) in the first year after index endoscopy in non-dysplastic BE (NDBE), low-grade or indefinite dysplasia. The proportions of PEEC defined using EAC alone and EAC+HGD were calculated by dividing EAC or EAC+HGD in the first year over the total number of EAC or EAC+HGD, respectively.

Results

We included 52 studies with 145,726 patients and median follow-up of 4.8 years. The proportion of PEEC (EAC) was 21% (95% CI 13-31) and PEEC (EAC+HGD) was 26% (95% CI 19-34). Among studies with NDBE only, PEEC (EAC) proportion was 17% (95% CI 11-23) and PEEC (EAC+HGD) was 14% (95% CI 8-19). Among studies with ≥5 years of follow-up, PEEC (EAC) proportion was 10% and PEEC (EAC+HGD) was 19%. Meta-regression analysis demonstrated a strong inverse relationship between PEEC and incident EAC (P<0.001). The PEEC (EAC) proportion increased from 5% in studies published <2000 to 30% after 2015. Substantial heterogeneity was observed for most analyses.

Conclusion

PEEC accounts for a high proportion of HGD/EACs and is proportional to reduction in incident EAC. Using best endoscopic techniques now and performing future research on improving neoplasia detection through implementation of quality measures and educational tools is needed to reduce PEEC.

You can read an interview with two of the study's authors here, and about the clinical implications of the study here.