Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans - 23/08/11

Doi : 10.1016/j.gie.2008.02.062

Joel H. Rubenstein, MD, MSc ^⁎, Amnon Sonnenberg, MD, MSc, Jennifer Davis, MHSA, Laurence McMahon, MD, MPH, John M. Inadomi, MD
Current affiliations: Gastroenterology Section (J.H.R., L.M.), VA Center for Clinical Management Research (J.D.), Ann Arbor Veterans Affairs Medical Center, Division of Gastroenterology (J.H.R.), Division of General Medicine (L.M.), University of Michigan Medical School, Ann Arbor, Michigan, Division of Gastroenterology (A.S.), Oregon Health and Science University, Portland, Oregon, Gastroenterology Division (J.M.I.), University of California, San Francisco, California, GI Health Outcomes, Policy and Economics (HOPE) Research Program (J.M.I), University of California, San Francisco, San Francisco, California, Division of Gastroenterology (J.M.I.), San Francisco General Hospital, San Francisco, California, USA

Reprint requests: Joel H. Rubenstein, MD, VA Medical Center (111-D), 2215 Fuller Rd, Ann Arbor, MI 48105.

Ann Arbor, Michigan, Portland, Oregon, San Francisco, California, USA

Abstract

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.

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Abbreviations : ACG, BE, EAC, GER, HR, ICD, NPCD, OR, VA