Abstract
BackgroundBarrett’s esophagus is strongly associated with esophageal adenocarcinoma. Considering costs and risks associated with invasive surveillance endoscopies better methods of risk stratification are required to assist decision-making and move toward more personalised tailoring of Barrett’s surveillance.MethodsA Bayesian network was created by synthesizing data from published studies analysing risk factors for developing adenocarcinoma in Barrett’s oesophagus through a two-stage weighting process.ResultsData was synthesized from 114 studies (n = 394,827) to create the Bayesian network, which was validated against a prospectively maintained institutional database (n = 571). Version 1 contained 10 variables (dysplasia, gender, age, Barrett’s segment length, statin use, proton pump inhibitor use, BMI, smoking, aspirin and NSAID use) and achieved AUC of 0.61. Version 2 contained 4 variables with the strongest evidence of association with the development of adenocarcinoma in Barrett’s (dysplasia, gender, age, Barrett’s segment length) and achieved an AUC 0.90.ConclusionThis Bayesian network is unique in the way it utilizes published data to translate the existing empirical evidence surrounding the risk of developing adenocarcinoma in Barrett’s esophagus to make personalized risk predictions. Further work is required but this tool marks a vital step towards delivering a more personalized approach to Barrett’s surveillance.
Highlights
The incidence of esophageal malignancy has increased markedly within the Western World in recent decades [1, 2]
A Bayesian network was created by synthesizing data from published studies analysing risk factors for developing adenocarcinoma in Barrett’s oesophagus through a two-stage weighting process
Data was synthesized from 114 studies (n = 394,827) to create the Bayesian network, which was validated against a prospectively maintained institutional database (n = 571)
Summary
The incidence of esophageal malignancy has increased markedly within the Western World in recent decades [1, 2]. Barrett’s esophagus has a 30 to 125 times greater risk of developing esophageal adenocarcinoma compared to age matched population [2,3,4]. Barrett’s surveillance screening has been recommended as this has been shown to detect disease at an earlier stage resulting in prolonged survival times. The relative rarity of malignancy balanced against the invasiveness of upper gastrointestinal endoscopy, has meant that the cost-effectiveness of Barrett’s surveillance depends on the risk of cancer with a wide variation in this risk being observed and reported [1, 2]. Barrett’s esophagus is strongly associated with esophageal adenocarcinoma. Considering costs and risks associated with invasive surveillance endoscopies better methods of risk stratification are required to assist decision-making and move toward more personalised tailoring of Barrett’s surveillance
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