Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans

Background

The efficacy of screening and surveillance EGD for esophageal adenocarcinoma (EAC) is controversial.

Objective

To examine the effect of an EGD before the diagnosis of EAC on survival after the diagnosis of cancer among patients with gastroesophageal reflux (GER).

Design

A retrospective, controlled cohort study.

Subjects

The national administrative databases of the Veterans Affairs were accessed, and patients diagnosed with EAC, from 1995 through 2003, who had a prior diagnosis consistent with GER were identified. Electronic medical records were then abstracted. Cases were subjects who had an EGD performed between 1 and 5 years before the diagnosis of EAC; controls were those subjects without a prior EGD.

Results

A total of 155 subjects with EAC and GER were identified. Cases with a history of an EGD at least 1 year before a diagnosis of EAC (n = 25) were diagnosed at earlier stages than those without a prior EGD (P = .02) but did not experience a significant improvement in survival (adjusted hazard ratio 0.93 [95% CI, 0.58–1.50]). Cases who had been enrolled in surveillance programs that adhered to published guidelines trended toward improved survival, but long-term survival reverted toward the rate found without any surveillance.

Conclusions

A prior EGD was associated with an improved stage at the diagnosis of EAC but did not alter long-term survival. In the absence of prospective, randomized, controlled trials, the benefit of screening and surveillance to decrease mortality from EAC cannot be confirmed.

Abbreviations: ACG, American College of Gastroenterology, BE, Barrett's esophagus, EAC, esophageal adenocarcinoma, GER, gastroesophageal reflux, HR, hazard ratio, ICD, International Classification of Diseases, NPCD, National Patient Care Datasets, OR, odds ratio, VA, United States Department of Veterans Affairs