Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Gastroenterol. 2017 Jul;112(7):1049-1055. doi: 10.1038/ajg.2017.18. Epub 2017 Feb 28.
Endoscopic surveillance is recommended for patients with Barrett's esophagus (BE). However, it remains unclear if all BE patients benefit from long-term surveillance. We investigated the risk of esophageal adenocarcinoma (EAC) in BE patients in relation to number of successive endoscopies, years of follow-up, and calendar year.
We conducted a retrospective cohort study of male veterans with newly diagnosed BE during 2004-2009 with follow-up until 30 September 2011. EAC was verified using detailed structured electronic medical records reviews. We used Poisson regression to determine incidence rates, rate ratios (RR), and corresponding 95% confidence intervals (CI) for EAC according to number of successive endoscopies, years of follow-up independent of number of follow-up endoscopies, and calendar year of BE diagnosis.
Among 28,561 male patients with BE, 406 developed EAC during 140,499 person-years of follow-up (median 4.9 years). EAC incidence rates increased with each additional endoscopy following a previous negative endoscopy (RR per additional endoscopy, 1.43; 95% CI, 1.25-1.64). Compared to the EAC incidence rate at the 1st follow-up EGD, the EAC incidence rate at the 5th follow-up EGD was ninefold higher (adjusted RR, 8.82; 95% CI, 4.90-15.9). EAC incidence was highest at the first year of follow-up (5.34 per 1,000 person-years); however, EAC rates starting from the second follow-up year increased during successive years of follow up. Compared to the EAC incidence rate in the 2nd year of follow-up, the EAC incidence rate was 1.5-fold higher in EGDs conducted ≥5 years after the index BE date (adjusted RR, 1.49; 95% CI, 1.07-2.10). In contrast, we found no significant change in EAC incidence rates by calendar year.
Persistence of non-neoplastic BE on multiple consecutive endoscopies was not associated with lower EAC risk. These findings argue against discontinuation of endoscopic surveillance in patients with persistent nondysplastic BE after multiple negative endoscopies.
内镜监测被推荐用于 Barrett 食管（BE）患者。然而，目前尚不清楚所有 BE 患者是否都能从长期监测中获益。我们研究了 BE 患者的食管腺癌（EAC）风险与连续内镜检查次数、随访年限以及日历年度之间的关系。
我们对 2004 年至 2009 年期间新诊断为 BE 的男性退伍军人进行了回顾性队列研究，随访至 2011 年 9 月 30 日。通过详细的结构化电子病历回顾来验证 EAC。我们使用泊松回归来确定 EAC 的发生率、率比（RR）以及根据连续内镜检查次数、独立于随访内镜检查次数的随访年限以及 BE 诊断的日历年度确定 EAC 的相应 95%置信区间（CI）。
在 28561 名 BE 男性患者中，有 406 名患者在 140499 人年的随访中发生了 EAC（中位随访时间为 4.9 年）。随着前一次阴性内镜检查后进行的额外内镜检查次数的增加，EAC 的发生率也随之增加（每次额外内镜检查的 RR，1.43；95%CI，1.25-1.64）。与第 1 次随访内镜检查的 EAC 发生率相比，第 5 次随访内镜检查的 EAC 发生率高 9 倍（校正 RR，8.82；95%CI，4.90-15.9）。在随访的第 1 年，EAC 的发生率最高（每 1000 人年 5.34 例）；然而，从第 2 年开始，随着随访年限的增加，EAC 的发生率也逐年增加。与第 2 年的 EAC 发生率相比，在 BE 确诊后≥5 年进行的内镜检查中，EAC 的发生率高 1.5 倍（校正 RR，1.49；95%CI，1.07-2.10）。相比之下，我们没有发现 EAC 发生率随日历年度而显著变化。
在多次连续内镜检查中持续存在非肿瘤性 BE 并不能降低 EAC 的风险。这些发现表明，在多次阴性内镜检查后，对于持续存在非异型增生性 BE 的患者，不应停止内镜监测。
