Clinical ResearchPreoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: A systematic review*,**
Section snippets
Methods
We performed a systematic review of the published English language literature from 1966 to May 2000 to identify observational studies of patient cohorts undergoing resection for high-grade dysplasia or adenocarcinoma of the esophagus, gastroesophageal junction, or gastric cardia. An initial, computerized database search of the English language literature from 1966 to May 2000 was performed using MEDLINE/HealthSTAR (National Library of Medicine, Bethesda, MD). The search strategy combined the
Results
We identified and reviewed 752 study titles based on our search of MEDLINE/HealthSTAR. Reviewer number 1 selected 36 papers for review, including all 21 papers selected by reviewer number 2 (see Tables 1 and 2).Years of publication Titles Abstracts Papers Included 1966-1974 4 1 0 0 1975-1979 9 3 0 0 1980-1984 37 7 1 0 1985-1989 101 25 12 1 1990-1994 195 32 12 4 1995-2000 406 29 11 7 Total 752 97 36 12 Years of publication Titles Abstracts Papers
Discussion
Our systematic review suggests that the vast majority of patients reported to have undergone resection for incident esophageal adenocarcinoma were not previously diagnosed with Barrett's esophagus. The implications of this finding are clear. Surveillance of patients with known Barrett's esophagus—although potentially beneficial to those individuals enrolled—has had minimal capacity for impact on esophageal adenocarcinoma outcomes at the population level, because the majority of patients were
Acknowledgements
The authors wish to thank Ian Gralnek, M.D., M.S.H.S., Paul Shekelle, M.D., Ph.D., and Dennis M. Jensen, M.D., for their insightful comments.
References (54)
Barrett's esophagus, dysplasia, and adenocarcinoma
Hum Pathol
(1994)Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus. The Practice Parameters Committee of the American College of Gastroenterology
Am J Gastroenterol
(1998)- et al.
Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings [see comments]
Gastroenterology
(1990) Treatment of carcinoma of the esophagus or cardia
Mayo Clin Proc
(1989)Abdominal and right thoracotomy approach as standard procedure for esophagogastrectomy with low morbidity
J Thorac Cardiovasc Surg
(1987)- et al.
Comparative features of esophageal and gastric adenocarcinomas: recent change in type and frequency
Hum Pathol
(1986) - et al.
Radical esophageal resection for adenocarcinoma arising in Barrett's esophagus
Am J Surg
(1997) - et al.
Adenocarcinoma in columnar-lined Barrett's esophagus. Analysis of 13 esophagectomies
Am J Surg
(1985) - et al.
Management of adenocarcinoma in a columnar-lined esophagus
Ann Thorac Surg
(1985) - et al.
Adenocarcinoma of the esophagus and Barrett's esophagus: a population-based study
Am J Gastroenterol
(1999)
Adenocarcinoma of the esophagogastric junction and Barrett's esophagus
Gastroenterology
Prevalence and characteristics of Barrett esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction
Hum Pathol
Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett's esophagus with high-grade dysplasia
Gastrointest Endosc
The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus
N Engl J Med
The changing epidemiology of esophageal cancer
Semin Oncol
SEER Cancer Statistics Review, 1973-1997: Table VIII-4
Cancer Statistics Review 1993-1994
NIH Publication No. 97-2789
Epidemiology of esophageal cancer, especially adenocarcinoma of the esophagus and esophagogastric junction
Recent Results Cancer Res
Malignant progression in Barrett's esophagus: pathology and molecular biology
Recent Results Cancer Res
Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia
Cancer
Is Barrett's metaplasia the source of adenocarcinomas of the cardia?
Arch Surg
Meta-analysis, decision analysis, and cost-effectiveness analysis: methods for quantitative synthesis in medicine
Early diagnosis of adenocarcinoma developing in Barrett's esophagus
Arch Surg
Adenocarcinoma of the esophagus and/or gastric cardia
Cancer
Primary adenocarcinoma of the esophagus
J Surg Oncol
Adenocarcinoma of the lower esophagus. A disease primarily of white men with Barrett's esophagus
J Clin Gastroenterol
Early detection of adenocarcinoma of the esophagus
Endoscopy
Cited by (307)
Esophageal adenocarcinoma heterogeneity in clinicopathology and prognosis: A single center longitudinal study of 146 cases over a 20-year period
2024, Annals of Diagnostic PathologyQuality in Barrett's Esophagus: Diagnosis and Management
2022, Techniques and Innovations in Gastrointestinal EndoscopyCitation Excerpt :This screening approach relies on patients undergoing an endoscopy which carries risk, cost, and limited practical feasibility. Among patients who underwent surgical resection for esophageal cancer, 95% of patients did not carry a previous diagnosis of Barrett's esophagus suggesting that the screening platforms are missing vast majority of patients who are diagnosed with esophageal cancer.22 The focus on symptoms of gastroenterology reflux disease also may be limiting as studies suggest that at least 40% of patients diagnosed with esophageal cancer did not complain of heartburn and/or regurgitation.23
Incomplete Response of Gastroesophageal Reflux Symptoms Poorly Predicts Erosive Esophagitis or Barrett's Esophagus
2021, Clinical Gastroenterology and HepatologyComment on: Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review
2021, Surgery for Obesity and Related Diseases
- *
Address requests for reprints to: Gareth S. Dulai, M.D., Greater Los Angeles Veterans Administration Healthcare System, CURE Digestive Diseases Research Center, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, California 90073.
- **
Dr. Dulai was supported by an Outcomes Research Training Award from the American Digestive Health Foundation, a Veterans Administration Ambulatory Care Fellowship, and the STAR program at UCLA. Dr. Guha is supported by the STAR fellowship program at UCLA.