- Design
- Nationwide registry cohort
- Population
- 8,914 patients treated for Barrett-related dysplasia or adenocarcinoma, 2008-2018
- Primary outcome
- Proportion with versus without prior endoscopy
- Effect
- 90% de novo (95% CI 89-91%); 65% of endoscopically treated de novo
A nationwide Dutch registry study included 8,914 people who received curative treatment for Barrett-related dysplasia or oesophageal adenocarcinoma between 2008 and 2018, and checked whether they had a previous endoscopy showing non-dysplastic Barrett's oesophagus.
Ninety per cent presented de novo, without any prior endoscopy. Even among those treated endoscopically, at an early, organ-preserving stage, 65% were de novo. Advanced disease, stage II or above, was found in 70% of de novo patients against 11% of those under surveillance. Among people already under surveillance, 11% nonetheless had advanced neoplasia at diagnosis.
Surveillance works for those in it: they were diagnosed earlier. But it reaches only a small minority of the people who go on to develop cancer, because most Barrett's oesophagus is never diagnosed. That shifts the question from surveillance intervals to who should be screened in the first place.
- Keep patients with known Barrett's oesophagus in surveillance; they were diagnosed at earlier stages.
- Most Barrett-related cancers arise in people never previously scoped.
- Consider screening endoscopy in patients with multiple risk factors, such as long-standing reflux, male sex, older age, obesity and family history.
- Investigate new dysphagia or weight loss promptly, whatever the surveillance history.
Why it matters
Surveillance catches early disease but misses most patients, so the gain now lies in finding Barrett's in the first place.
Don't overread it
A registry study of treated patients; it does not show that screening would reduce deaths.
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