The incidence of adenocarcinoma in Barrett's esophagus: a prospective study of 170 patients followed 4.8 years

Abstract

Objectives: Barrett's esophagus is a premalignant condition defined by the presence of intestinal metaplasia in the esophagus. Estimates of the incidence of adenocarcinoma developing in patients with Barrett's esophagus vary widely. We prospectively followed a cohort of patients to define the incidence.

Methods: Between January 1982 and April 1995, all patients undergoing upper endoscopy at the VA Medical Center in Tucson, AZ, were surveyed for Barrett's esophagus. One hundred seventy-seven patients (174 males, three females) were found to have Barrett's esophagus. Seven of 177 were found to have adenocarcinoma either at initial endoscopy or within 6 months, resulting in a prevalence of 4%. One hundred seventy of 177 patients initially lacking cancer were available for systematic survey.

Results: The mean age at the time of Barrett's diagnosis was 62 yr (range 30-85 yr). The mean follow-up period was 57 months or 4.8 yr (range 6-156 months), for a total of 834 patient-years. Adenocarcinoma developed in four patients, an incidence of 1/208 patient-years of follow-up.

Conclusions: The current series is larger and has a longer follow-up period than previous prospective trials and demonstrates a lower incidence of adenocarcinoma. Surveillance of patients with Barrett's esophagus for dysplasia remains an appropriate clinical practice.