High Rate of Missed Esophageal Adenocarcinoma in Barrett Esophagus

An estimated 33% of esophageal adenocarcinomas were diagnosed within 1 year of negative index endoscopy.

Most patients with esophageal adenocarcinoma (EAC) related to Barrett esophagus (BE) are diagnosed at the original endoscopy; hence the prevalence of EAC is much greater than the incidence. Although no cancer screening test is perfect, EAC discovered within a year of a negative index endoscopy likely reflects a missed cancer. The frequency of missed EAC is unclear.

A systematic review of all published cohort studies in adults with BE with no dysplasia or low-grade dysplasia at baseline and with ≥3 years of follow-up yielded 27 studies (6 U.S., 20 European, 1 Australian). Surgical and ablative procedural series were excluded. Biopsy protocol was described in 20 studies, but recommended standard 4-quadrant biopsy every 1 to 2 cm was used in on…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors