Global 
Deutschland Endoscopy
Clin Gastroenterol Hepatol. 2026;24(3):667-677
Neoplasia detection rate and risk of post-endoscopy esophageal adenocarcinoma and neoplasia in a population-based cohort study
Background and aims: Post-endoscopy esophageal adenocarcinoma (PEEC) and esophageal neoplasia (PEEN) undermine early cancer detection in Barrett’s esophagus (BE). The study aimed to assess the association between facility neoplasia detection rate (NDR) and risk of PEEC/PEEN among newly diagnosed patients with BE.
Methods: This population-based cohort study included 15,178 patients with BE from Finland and Sweden between 2006 and 2020. PEEC and PEEN were defined as esophageal adenocarcinoma (EAC) or high-grade dysplasia (HGD)/EAC, respectively, diagnosed 30 to 365 days from BE diagnosis. Cancer detection rate (CDR) was defined as EAC alone and NDR as HGD/EAC diagnosed from 0 to 29 days, and both were calculated as a 2-year moving average. Incident HGD/EAC was diagnosed > 365 days from BE diagnosis. Patients were followed until HGD/EAC, death, or the end of the study period. Incidence rates and mortality rates per 100,000 person-years with 95% confidence intervals (CIs) were calculated. Associations between CDR/NDR and PEEC/PEEN were assessed using Poisson modelling with quadratic term for log(F-NDR).
Results: Among 198 patients who developed EAC during follow-up, 36 (18%) were diagnosed within 30 days of endoscopy, 44 (22.2%) were PEEC, and 118 (59.6%) were incident EAC. The incidence rates per 100,000 person-years for PEEC and incident EAC were 341 (95% CI: 254–458) and 193 (95% CI: 161–231), respectively. The mean CDR was 0.23, and the mean NDR was 0.39. All-cause and EAC-specific mortality rates per 100,000 person-years were 3782 (95% CI: 3645–3924) and 121 (95% CI: 98–149). The adjusted hazard ratios for PEEC and PEEN based on CDR was 0.18 (95% CI: 0.06–0.56) and 0.08 (95% CI: 0.02–0.36), respectively.
Conclusions: This study has provided population-based estimates of CDR and NDR and associations between CDR/NDR and PEEC/PEEN. Future studies remain to determine whether improving CDR/NDR decrease the incidence of PEEC/PEEN.