Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study

OBJECTIVES: To review the benefit of an endoscopic surveillance programme for patients with Barrett's oesophagus. DESIGN: Observational study. SETTING: University teaching hospital. PARTICIPANTS: 409 patients in whom Barrett's oesophagus was identified during 1984-94; 143 were entered into the annual surveillance programme. MAIN OUTCOME MEASURES: Development of dysplasia and cancer and mortality. RESULTS: The average period of surveillance was 4.4 years; 55 patients were reassessed in 1994 but only eight remained in the programme in 1999, withdrawal being due to death (not from carcinoma of the oesophagus), illness, or frailty. Five of the patients who entered surveillance developed carcinoma of the oesophagus. Only one cancer was identified as a result of a surveillance endoscopy, the others being detected during endoscopy to investigate altered symptoms. Of the 266 patients who were not suitable for surveillance, one died from oesophageal cancer and 103 from other causes. Surveillance has resulted in 745 endoscopies and about 3000 biopsy specimens. CONCLUSION: The current surveillance strategy has limited value, and it may be appropriate to restrict surveillance to patients with additional risk factors such as stricture, ulcer, or long segment (>80 mm) Barrett's oesophagus.