Risk of oesophageal adenocarcinoma in individuals with Barrett's oesophagus

Abstract

Introduction: Recent studies have indicated a lower incidence rate of oesophageal adenocarcinoma (OAC) in individuals with Barrett's oesophagus (BO) than most earlier studies. Our objective was to assess the risk of OAC in a Swedish unselected cohort of individuals with BO.

Methods: This population-based cohort study included all Swedish residents diagnosed with BO in 2006-2013, identified through the Swedish Patient Registry. The cohort members were followed from the date of first BO diagnosis until the first occurrence of OAC, high-grade dysplasia (HGD), death, emigration or end of study period. The main outcome was incidence rates with 95% confidence intervals (CIs) of OAC.

Results: Among 7932 participants with BO and 18,415 person-years of follow-up, the overall incidence of OAC was 1.47 (95% CI 0.91-2.02) per 1000 person-years. When stratified into follow-up periods after BO diagnosis, the incidence rate of OAC was 15.53 (4.77-26.29) from 7 to 30 d, 4.10 (0.82-7.38) from 31 to 100 d, 1.87 (0.00-3.99) from 101 d to 6 months, 1.44 (0.18-2.70) from >6 months to 1 year, 0.94 (0.36-1.53) from >1 year to 3 years and 2.17 (1.14-3.21) from >3 years to the end of follow-up. The median follow-up time was 2.13 person-years.

Conclusion: This population-based study indicates that OAC is primarily diagnosed during the first months following an initial diagnosis of BO. This could justify a changed surveillance strategy of BO with a repeated thorough endoscopy shortly after initial BO diagnosis to identify prevalent early OAC or HGD.

Keywords: Barrett's oesophagus; High-grade dysplasia; Oesophageal adenocarcinoma; Oesophageal neoplasm; Surveillance.