FA02.01: PREVALENCE AND RISK FACTORS FOR ESOPHAGEAL CANCER FOLLOWING ACHALASIA TREATMENT: NATIONAL POPULATION-BASED CASE-CONTROL STUDY

Abstract

Abstract Background Achalasia is associated with an increased risk of esophageal cancer, however the specific population at greatest risk remains unknown. The objectives of the present study were from a large national population based cohort study to: (i) Identify the prevalence of esophageal cancer in treated achalasia patients. (ii) Consider patient and treatment related risk factors, associated with an increased prevalence of esophageal cancer. Methods Patients with esophageal achalasia diagnosed and receiving a treatment between 2002 and 2012 were identified from the Hospital Episode Statistics database. The primary outcome measure was esophageal cancer. All patients with a diagnosis of esophageal cancer within one year of achalasia primary treatment were excluded to avoid inclusion of pseudoachalasia patients. Patient and treatment factors were compared between patients who developed esophageal cancer and those that did not using univariate and multivariate analyses. Results Over the 11-year study period 7487 patients receiving an interventional treatment for esophageal achalasia were included and 101 patients (1.3%) developed esophageal cancer. The median time to cancer development was 3 years (range 1 to 11 years) from primary achalasia treatment. Patients who developed esophageal cancer were older with a greater proportion of patients aged > 60 (71.3% vs. 45.4%; P < 0.001), and more commonly were primarily treated with pneumatic dilation (82.2% vs. 60.3%; P < 0.001). In the esophageal cancer group there was also an increase in the number of patients requiring re-interventions (47.5% vs. 38.0%; P = 0.041) and the average total number of re-interventions per patient over the study period (1.2 vs. 0.8; P = 0.026). Subset analyses for surgical myotomy and pneumatic dilation primary treatment groups showed similar associations between re-intervention and increased risk of cancer. Multivariate analysis confirmed associations between increased patient age (> 80 years, HR = 18.71; 95%CI 4.30–81.44) and pneumatic dilation (HR = 2.27; 95%CI 1.03–5.03), and risk of esophageal cancer. Conclusion This national achalasia population based case-control study identified increasing patient age, pneumatic dilation and re-intervention as potential risk factors associated with the development of esophageal cancer. Patients with these risk factors should receive more intensive endoscopic surveillance to ensure esophageal cancer is appropriately diagnosed at an early stage. Disclosure All authors have declared no conflicts of interest.