4914 Life expectancy and cancer risk in patients with barrett's esophagus: a prospective controlled investigation.

Abstract

Background and Aims: Studies from tertiary referral centers suggest that patients with BE have an increased incidence of esophageal and possibly extraesophageal cancers. This study determines the incidence of cancers and survival rates in less selected patients with BE and compares these findings with those obtained in patients with achalasia, Schatzki rings and in an average population. Methods: From 1979 to 1994 sixty consecutive patients (mean age: 60.8±14.1 years, 35 males and 25 females) with newly diagnosed BE (specialized epithelium with no dysplasia at initial diagnosis and BE-length of more than 3cm) were diagnosed in a single GI consultation office and followed until 1999 when all patients and/or their physicians were again contacted and interviewed. Cancer incidence and survival rates (Kaplan Meier estimates) were compared with an identical number of age and sex matched patients with symptomatic Schatzki rings (SR) and achalasia (A) who were observed and followed during the same time period and in the same institution. In addition, from published data on the life expectancy of the average German population (Bundesamt fur Statistik 1995), we generated survival data for an average but age and sex matched population and compared these findings with those obtained in patients with BE, A and SR.Results: Complete follow-up information was obtained in 95% of patients with BE, 98.3% of patients with SR and 98.3% of patients with A. Within a mean observation period of 9.9±5.3 years (mean±1SD), 2 patients with BE (3.3%; 95%CI=0.4,11.5%) developed esophageal and 9 (15%;95%CI=7.0,26.5%) extraesophageal cancers. These data differed only mildly from those of patients with Schatzki rings (esophageal cancer:1.6%;95%CI=0.04,8.9%, extraesophageal cancers: 15%;95%CI=7.0,26.5%) and achalasia (no esophageal cancers, extraesophageal cancers: 5%; 95%CI=1.0, 13.9%). Estimated ten year survival rates were similar in patients with BE (83%), patients with symptomatic Schatzki rings (80%) and patients with achalasia (87%) and did not differ from those of an age and sex matched average population (82%). Conclusions: The cancer risk in patients with Barrett's syndrome has been over-estimated. If less selected patients are followed, one esophageal cancer will develop in approximately 300 patient years. Life expectancy of these patients does neither differ from that of patients with other benign esophageal disorders nor from the average population.