A recent study published in Gastroenterology by Wani et al found that at least a quarter of all esophageal adenocarcinomas may be detected within a year of a negative upper endoscopy in patients with newly diagnosed Barrett's esophagus. The investigators proposed methods for improving the efficacy of screening and surveillance practices for early cancer detection in these patients.
Barrett’s esophagus is the only identifiable precursor lesion for esophageal adenocarcinoma, a lethal cancer type that has seen increased incidence and mortality rates over the past several decades.
Study Methods and Results
In the new population-based cohort study, the investigators analyzed the data from a large international database of over 20,000 patients who were newly diagnosed with Barrett’s esophagus between 2006 and 2020—with the goal of better understanding how patients may have a normal endoscopy but still receive a diagnosis of esophageal adenocarcinoma in a short time frame.
“We found a high proportion of esophageal cancers were found in patients after receiving a normal endoscopy and before the next recommended endoscopy,” explained lead study author Sachin Wani, MD, FASGE, Professor of Medicine in the Division of Gastroenterology and Hepatology at the Anschutz Medical Center and Director of the Katy O. and Paul M. Rady Esophageal and Gastric Center of Excellence at the University of Colorado Cancer Center.
The investigators discovered that 25% to 46% of esophageal adenocarcinoma cases were categorized as postendoscopy esophageal adenocarcinomas—which are identified within 1 year of a nondiagnostic upper endoscopy.
“These missed cancers can impact survival rates, since catching cancer early is critical for effective treatment,” Dr. Wani stressed. The investigators noted that understanding these missed cancers may also provide information that can help researchers develop more effective interventions.
Conclusions
“In the past, research was mostly focused on observational studies that were plagued by small sample sizes or selection bias. This means we didn’t have a true picture of how current screening practices aren’t working for nearly a quarter of patients [with esophageal adenocarcinomas]. With this new research, we’re providing more data, which is an opportunity to improve the effectiveness of screening and surveillance practices,” highlighted Dr. Wani.
Although the investigators were uncertain of why current screening and surveillance strategies are ineffective for about 25% of patients, they proposed several possible solutions to improve screenings.
“We suggest providers use the highest-quality endoscopy equipment, spend adequate time inspecting the Barrett’s segment, and ensure that they have the most rigorous sampling protocols in place,” Dr. Wani recommended. “At the end of the day, we hope this data can influence providers in clinical practice to improve the quality of care and endoscopies for [patients with Barrett’s esophagus],” he concluded.
Further studies may be needed to examine the role of other diagnostic techniques using biomarker panels to predict prevalent and incident Barrett’s esophagus–related esophageal adenocarcinomas.
Disclosure: For full disclosures of the study authors, visit gastrojournal.org.
