Tackling Prevention and Early Diagnosis of Esophageal Adenocarcinoma through a National Barrett's Registry and Scientific Network

Abstract

Objective: To evaluate the progression rate of Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) using a prospectively maintained national registry, quality-assured endoscopy and expert pathology.

Summary of background data: BE is the sole pathologic precursor of EAC. Targeting prevention and early diagnosis through quality-assured BE programs has a compelling rationale.

Methods: A Barrett's Registry and Bioresource was founded in 2011, and data to November 2024 was prospectively documented in a web-based system (Dendrite, UK). Endoscopy and pathology (of specialized intestinal metaplasia) were strictly quality assured per current guidelines. Expert gastrointestinal pathologists classified non-dysplastic BE (NDBE), indefinite for dysplasia (IND), low-grade dysplasia (LGD), and high-grade dysplasia (HGD). Endoscopic eradication therapies were monitored. Multivariable regression models evaluated risk factors for progression, and Kaplan-Meier curves were constructed for overall progression, and progression excluding the first year following the index biopsy.

Results: 9,436 patients were registered, with a median follow up of 4.4y, and 5,331 had at least one follow-up endoscopy. Overall, 252 cases (4.7%, 95% CI 1.70-2.18) of HGD and 255 cases (4.7%, 95% CI 1.72-2.20) of EAC were diagnosed. Among these, 150 cases (2.8%. 95% CI 1.05-1.44) of HGD and 148 (2.7%, 95% CI 1.05-1.44) of EAC were diagnosed more than one year after the index endoscopy. The overall incidence of HGD/EAC combined was 2.42%(95% CI 2.14-2.73), 6.59%(95% CI 5.14-8.46), and 13.79%(95% CI 11.94-15.93) per year in NDBE, IND and LGD, respectively. Independent risk factors include male gender (HR 0.655,95% CI 0.56-0.896,P<0.004), age (HR 1.027, 95% CI 1.02-1.04,P<0.001) and Barrett's length (HR 1.635,95% CI 1.33-2.01,P<0.001). 604 (6.4%) patients underwent RFA, with a complete eradication of SIM in 80.5% and 10 (1%) patients required resectional surgery. Cancer specific survival in the total cohort was 100%.

Conclusions: A structured high volume Barrett's program, underpinned by quality assurance, provides data that highlights a strategy that provides proof of concept in targeting prevention and early detection, and is anticipated to reduce mortality.

Keywords: Barrett’s Esophagus; esophageal adenocarcinoma; gastrointestinal cancer; registry; surveillance.