ArticleAnnals of surgery2025
Tackling Prevention and Early Diagnosis of Esophageal Adenocarcinoma Through a National Barrett's Registry and Scientific Network.
Article in Annals of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Centralised management of Barrett's oesophagus surveillance: assessing progression risk and management.Journal of thoracic disease · 2026Article
- Barrett's oesophagus surveillance in a centralised system: implications for progression risk and management.Journal of thoracic disease · 2026Article
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16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the progression rate of Barrett esophagus (BE) to esophageal adenocarcinoma (EAC) using a prospectively maintained national registry, quality-assured endoscopy, and expert pathology.
backgroundBE is the sole pathologic precursor of EAC. Targeting prevention and early diagnosis through quality-assured BE programs has a compelling rationale.
methodsA Barrett's Registry and Bioresource was founded in 2011, and data to November 2024 were 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 after the index biopsy.
resultsNine thousand four hundred thirty-six patients were registered, with a median follow-up of 4.4 years, and 5331 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 1 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 sex [hazard ratio (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%.
conclusionsA 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.
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