内镜筛查阴性的胃食管反流病患者发生上消化道癌症的风险
Risk of upper gastrointestinal cancers in patients with gastroesophageal reflux disease after a negative screening endoscopy.
作者信息
Shakhatreh Mohammad H, Duan Zhigang, Avila Nathaniel, Naik Aanand D, Kramer Jennifer R, Hinojosa-Lindsey Marilyn, Chen John, El-Serag Hashem B
机构信息
Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
出版信息
Clin Gastroenterol Hepatol. 2015 Feb;13(2):280-6. doi: 10.1016/j.cgh.2014.06.029. Epub 2014 Jul 5.
BACKGROUND & AIMS: Practice guidelines recommend a 1-time screening endoscopy for patients with gastroesophageal reflux disease (GERD) who are at high risk for Barrett's esophagus or malignancy. However, little is known about the risk of cancer in patients with negative findings from screening endoscopies.
METHODS
We conducted a retrospective cohort study using data from 121 Veterans Health Administration facilities nationwide to determine the incidence rate of esophageal adenocarcinoma (EA) separately, as well as any upper gastrointestinal cancers, in patients with an initial negative screening endoscopy (esophagogastroduodenoscopy [EGD]). We included veteran patients with GERD diagnosed between 2004 and 2009 who had a negative screening EGD within 1 year of diagnosis. We estimated the incidence rate of EA, and any upper gastrointestinal cancer, in patients with GERD who had a negative screening EGD. We examined differences in demographic, clinical, and facility factors among patients with and without cancer.
RESULTS
We identified 68,610 patients with GERD and a negative screening EGD (mean age, 55.5 y; 90% men; 67.5% white). During a mean follow-up period of 3.2 years, 10 patients developed EA and 29 patients developed any upper gastrointestinal malignancies, including EA. The incidence of subsequent EA in this group was 4.6/100,000 patient-years of follow-up evaluation, whereas the incidence of any upper gastrointestinal cancers was 13.2/100,000 patient-years of follow-up evaluation. Patients with a subsequent cancer were significantly older and had higher comorbidity scores than patients without cancer. Other clinical and facility factors did not differ significantly between these 2 groups.
CONCLUSIONS
The risk of cancer is low, over a mean 3-year period, for patients with GERD who had a negative screening endoscopy. These findings justify recommendations for a 1-time screening endoscopy for patients with GERD.
背景与目的
实践指南建议，对于有巴雷特食管或恶性肿瘤高风险的胃食管反流病（GERD）患者进行一次性筛查内镜检查。然而，对于筛查内镜检查结果为阴性的患者患癌风险知之甚少。
方法
我们进行了一项回顾性队列研究，使用来自全国121个退伍军人健康管理局设施的数据，分别确定初次筛查内镜检查（食管胃十二指肠镜检查[EGD]）结果为阴性的患者中食管腺癌（EA）以及任何上消化道癌症的发病率。我们纳入了2004年至2009年间诊断为GERD且在诊断后1年内筛查EGD结果为阴性的退伍军人患者。我们估计了筛查EGD结果为阴性的GERD患者中EA以及任何上消化道癌症的发病率。我们检查了患癌患者和未患癌患者在人口统计学、临床和机构因素方面的差异。
结果
我们确定了68610例GERD且筛查EGD结果为阴性的患者（平均年龄55.5岁；90%为男性；67.5%为白人）。在平均3.2年的随访期内，10例患者发生了EA，29例患者发生了任何上消化道恶性肿瘤，包括EA。该组后续EA的发病率为每100000患者年随访评估4.6例，而任何上消化道癌症的发病率为每100000患者年随访评估13.2例。后续患癌患者比未患癌患者年龄显著更大且合并症评分更高。这两组在其他临床和机构因素方面没有显著差异。
结论
对于筛查内镜检查结果为阴性的GERD患者，平均3年期间的患癌风险较低。这些发现证明了对GERD患者进行一次性筛查内镜检查建议的合理性。
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