ReviewRisk of Esophageal Adenocarcinoma and Mortality in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis
Section snippets
Search Strategy
PubMed, EMBASE, and Web of Science databases were systematically searched for cohort studies reporting on EAC risk and mortality due to EAC in patients with BE, published between 1966 and September 2008. The following keywords were used for: (1) BE: Barrett's esophagus, Barrett's metaplasia, Barrett's mucosa, Barrett's epithelium, columnar-lined esophagus, specialized intestinal metaplasia; (2) EAC: esophageal adenocarcinoma, esophageal cancer, esophageal neoplasm, esophageal malignancy,
Results
The search strategy yielded 7200 abstracts, of which 190 were relevant to the review topic and subsequently reviewed. Following evaluation of the full text papers, 51 articles met the inclusion criteria and were included in the final analysis.2, 11, 12, 14, 15, 17, 18, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69
Discussion
Both the incidence rate of progression to EAC and mortality due to EAC are critical factors for the cost effectiveness of surveillance.13, 19 Our meta-analysis showed that the overall estimate of the incidence of EAC in patients with BE was 6.3 cases per 1000 pyrs and that the overall incidence of EAC and HGD combined was 10.2/1000 pyrs, which corresponded to an annual risk of 0.6% and 1.0%, respectively. Furthermore, the overall estimate of mortality due to EAC in patients with BE was 3.0/1000
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This article has an accompanying continuing medical education activity on page e32. Learning Objectives—At the end of this activity, the learner should recognize the low risk of esophageal adenocarcinoma in Barrett's esophagus and appreciate that no randomized trials have compared surveillance to a no surveillance strategy.
Conflict of interest The authors disclose no conflicts.