Barrett's Esophagus: Prevalence and Incidence of Adenocarcinoma

doi:10.1001/archinte.1991.00400110070014

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Vol. 151 No. 11, NOVEMBER 1991

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Barrett's Esophagus

Prevalence and Incidence of Adenocarcinoma

Warren A. Williamson, MD; F. Henry Ellis, Jr, MD, PhD; S. Peter Gibb, MD; David M. Shahian, MD; H. Thomas Aretz, MD; Gerald J. Heatley, MS; Elton Watkins, Jr, MD

Arch Intern Med. 1991;151(11):2212-2216.

Abstract

Between January 1973 and January 1989, 241 patients with Barrett'sesophagus were treated at the Lahey Clinic Medical Center, Burlington,Mass. Of these patients, 65 presented with adenocarcinoma inBarrett's esophagus for a prevalence rate of 27%. Of 176 patientsfollowed up for a total of 497 patient-years, adenocarcinomadeveloped in five patients for an incidence of one per 99 patient-years.The development of adenocarcinoma during endoscopic surveillance1, 2, 2, 4, and 10 years after the initial diagnosis of Barrett'sesophagus emphasizes the importance of long-term endoscopicand histologic surveillance. All five patients had severe dysplasiabefore adenocarcinoma developed. Yearly endoscopic follow-upexamination is recommended for all patients with Barrett's esophagusunless mild dysplastic changes are found, in which case surveillanceshould be increased. Patients with severe dysplasia who areotherwise acceptable candidates for operation should be advisedto have esophageal resection.

(Arch Intern Med. 1991;151:2212-2216)

Author Affiliations

From the Departments of Thoracic and Cardiovascular Surgery (Drs Williamson and Shahian), Gastroenterology (Dr Gibb), and the Sias Surgical Research Unit (Mr Heatley and Dr Watkins), Lahey Clinic Medical Center, Burlington, Mass, and the Overholt Division of Cardiothoracic Surgery (Dr Ellis) and the Department of Anatomic Pathology (Dr Aretz), New England Deaconess Hospital, Boston, Mass.

Footnotes

Accepted for publication May 31, 1991.

Reprint requests to the Department of Thoracic and CardiovascularSurgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington,MA 01805 (Dr Williamson).

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