Esophagus to Small Intestine
Gastroenterology. 2023;165(4):909–19.e13
Magnitude and time-trends of post-endoscopy esophageal adenocarcinoma and post-endoscopy esophageal neoplasia in a population-based cohort study: The Nordic Barrett’s Esophagus Study
Background and aims: Post-endoscopy esophageal adenocarcinoma (PEEC) and post-endoscopy esophageal neoplasia (PEEN) undermine early cancer detection in Barrett’s esophagus (BE). The authors aimed to assess the magnitude and conduct time-trend analysis of PEEC and PEEN among patients with newly diagnosed BE.
Methods: This population-based cohort study was conducted in Denmark, Finland, and Sweden between 2006 and 2020 and included 20,588 patients with newly diagnosed BE. PEEC and PEEN were defined as esophageal adenocarcinoma (EAC) or high-grade dysplasia (HGD)/EAC, respectively, diagnosed 30–365 days from BE diagnosis (index endoscopy). HGD/EAC diagnosed from 0–29 days and HGD/EAC diagnosed > 365 days from BE diagnosis (incident HGD/EAC) were assessed. Patients were followed up until HGD/EAC, death, or end of study period. Incidence rates (IRs) per 100,000 person-years with 95% confidence interval (CI) were calculated using Poisson regression.
Results: Among 293 patients diagnosed with EAC, 69 (23.5%) were categorized as PEEC, 43 (14.7%) as index EAC, and 181 (61.8%) as incident EAC. The IRs/100,000 person-years for PEEC and incident EAC were 392 (95% CI: 309–496), and 208 (95% CI: 180–241), respectively. Among 279 patients diagnosed with HGD/EAC (Sweden only), 17.2% were categorized as PEEN, 14.6% as index HGD/EAC, and 68.1% as incident HGD/EAC. IRs/100,000 person-years for PEEN, and incident HGD/EAC were 421 (95% CI: 317–558), and 285 (95% CI: 247–328), respectively. Sensitivity analyses that varied time interval for occurrence of PEEC/PEEN demonstrated similar results. A time-trend analysis for IRs demonstrated rising incidence rates of PEEC/PEEN.
Conclusions: Almost a quarter of all esophageal adenocarcinomas are detected within a year after an ostensibly negative upper endoscopy in patients with newly diagnosed Barrett’s esophagus. Interventions to improve detection may reduce post-endoscopy esophageal adenocarcinoma/post-endoscopy esophageal neoplasia rates.