1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

How Intense Does Barrett's Surveillance Need to Be?

Mucosal metaplasia in the esophagus (Barrett's esophagus) is assumed to be a premalignant condition; in hope of making early diagnoses of malignant lesions, regular endoscopic surveillance is recommended for many Barrett's patients. British investigators performed this analysis to evaluate the efficacy of such surveillance.

A total of 409 patients with Barrett's were identified from 1984 through 1994. Of these, 143 were enrolled in an annual surveillance program; the others were not included in the program for reasons such as age older than 70 (39 percent) or serious coexisting illness (10 percent). The average surveillance period was 4.4 years. Of the 5 patients who developed esophageal cancer, only 1 was identified during routine endoscopy; that patient died postoperatively. The other cancers were discovered by nonsurveillance endoscopies performed because of altered symptoms. Of the 266 patients not in the surveillance program, only 1 died from esophageal carcinoma, while 103 died from other causes. Overall, the surveillance program resulted in 745 endoscopies and almost 3000 biopsies.

Comment: This surveillance program seems to have yielded very limited value. The authors recommend that surveillance be restricted to the most high-risk patients, such as those with ulceration, stricture, or long-segment Barrett's, until the results from prospective studies are available. An editorialist concurs that surveillance should be limited primarily to those who are capable of undergoing esophagectomy and who have high-risk histologic changes.

— KI Marton

Published in Journal Watch General Medicine January 5, 2001

Citation(s):

Macdonald CE et al. Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesaphagus: Observational study. BMJ 2000 Nov 18 321 1252-1255.

• Original article (Subscription may be required)
• Medline abstract (Free)

McGarrity TJ. Barrett's oesaphagus: The continuing conundrum. Surveillance should be confined to the surgically fit. BMJ 2000 Nov 18 321 1238-1239.

• Original article (Subscription may be required)
• Medline abstract (Free)