Research Article|Articles in Press

Real-World Evidence of Safety and Effectiveness of Barrett’s Endoscopic Therapy

Published:March 11, 2023DOI:
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      Background and Aims

      Real-world data on the adverse events and the survival benefit of Barrett’s endoscopic therapy (BET) is limited. We aim to examine the safety and effectiveness (survival benefit) of BET in patients with neoplastic Barrett’s esophagus (BE).


      An electronic health record-based database (TriNetX) was utilized to select patients with BE with dysplasia and esophageal adenocarcinoma (EAC) from 2016 to 2020. Primary outcome was 3-year mortality among patients with high-grade dysplasia (HGD) or EAC who underwent BET versus two comparison cohorts: patients with HGD or EAC who had not undergone BET and patients with gastroesophageal reflux disease (GERD) but no BE/EAC. Secondary outcome was adverse events (esophageal perforation, upper gastrointestinal bleeding, chest pain, and esophageal stricture) following BET. 1:1 propensity score matching was performed to control for confounding variables.


      We identified 27,556 patients with BE and dysplasia, of which 5,295 underwent BET. Following propensity matching, patients with HGD and EAC who underwent BET had significantly lower 3-year mortality (HGD: RR=0.59, 95% CI 0.49-0.71; EAC: RR=0.53, 95% CI 0.44-0.65) compared with corresponding cohorts who did not undergo BET (p<0.001). There was no difference in median 3-year mortality between controls (GERD without BE/EAC) compared to patients with HGD (RR 1.04, 95% CI 0.84-1.27) who underwent BET. Finally, there was no difference in median 3-year mortality between patients who underwent BET compared to patients who underwent esophagectomy among both HGD (RR 0.67 [95% CI 0.39-1.14], p=.14) and EAC (RR 0.73 [95% CI 0.47-1.13], p=.14). Esophageal stricture was the most common adverse event (6.5%) following BET.


      Real-world, population-based evidence from this large database shows that endoscopic therapy is safe and effective for BE patients. Endoscopic therapy is associated with a significantly lower 3-year mortality; however, it leads to esophageal strictures in 6.5% of treated patients.


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