BACKGROUND: There is growing controversy over the cost-effectiveness of surveillance endoscopy for patients with Barrett's esophagus.
METHODS: A retrospective review was performed of patients surviving resection for Barrett's adenocarcinoma to assess the influence of endoscopic surveillance on long-term survival. From 1980 to 2000, 69 patients (65 men, 4 women) aged 61.4 years (range 35-84) survived resection for Barrett's adenocarcinoma. Fifteen were initially diagnosed with benign Barrett's esophagus and were followed in an endoscopic surveillance program. The remaining 54 patients had the initial diagnosis of Barrett's esophagus made at the time of their cancer diagnosis.
RESULTS: Patients in surveillance programs were younger (56 vs 63 yrs; p=0.06), experienced less preoperative weight loss (4.9 vs 12.0 lbs; p=0.1), had better dysphagia scores (1.6 vs 2.3; p=0.008), had a similar incidence of GERD symptoms (82% vs 69%), and did not undergo preoperative chemotherapy or radiotherapy. In contrast, 33% and 17% of non-surveillance patients had preoperative chemotherapy or radiation therapy, respectively. The surveillance group underwent transthoracic (73%) or transhiatal (27%) resection, while these resections were performed in 75% and 25%, respectively, of the non-surveillance group. Follow-up was complete in 67 (97%). Pathologic stage was 0 or I in 11/15 (73%) surveillance patients compared to 13/54 (24%) non-surveillance patients (p<0.001). Median survival for surveillance patients was 104 mos compared to 13 mos for non-surveillance patients (p<0.001). Weight loss (hazard ratio [HR] for 5 lb loss = 1.19; 95% confidence interval [CI] = 1.02-1.39; p=0.34) and surveillance (HR = 3.08; CI = 0.90-10.54; p=0.07) were predictors of survival (stratified by stage).
CONCLUSIONS: Surveillance endoscopy permits early diagnosis of adenocarcinoma in Barrett's patients and contributes substantially to long-term survival. An initial screening endoscopy for patients with substantial GERD symptoms may be useful in decreasing the mortality from Barrett's adenocarcinoma by determining which patients should be entered into a surveillance program.
