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Receipt of Serial Endoscopy Procedures Prior to Esophageal Adenocarcinoma Diagnosis Is Associated with Better Survival

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Abstract

Background

The poor prognosis of esophageal adenocarcinoma (EAC) has focused efforts on early detection by serial endoscopic surveillance of Barrett’s esophagus (BE). Previously, we reported that receipt of endoscopy before EAC diagnosis was associated with improved survival.

Aim

We aimed to refine our previous analysis, assessing surveillance as measured by performance of serial endoscopy before EAC diagnosis and evaluating its association with stage and survival.

Methods

A retrospective cohort study was performed using the Surveillance, Epidemiology and End Results-Medicare database. Patients aged ≥ 70 years with EAC diagnosed during 1998–2009 were identified. Diagnosis with BE and receipt of ≥ 2 upper endoscopic procedures within 5 years before cancer diagnosis were identified. We compared a reference group not receiving serial endoscopy to 3 patterns based on ≥ 2 endoscopy dates relative to a timepoint 2 years before cancer diagnosis: “remote,” “recent,” and “sustained.”

Results

Among 5532 patients, 28% (n = 1,575) had localized stage. Thirteen percent (n = 703) received ≥ 2 endoscopic procedures before cancer diagnosis: 224, 298, and 181 in the “recent,” “remote,” and “sustained” groups. Serial endoscopy and prior BE were associated with localized stage (“sustained” group OR 2.95, 95% confidence interval [CI] 2.07, 4.19; prior BE OR 2.68, 95% CI 2.03, 3.56). Serial endoscopy was associated with improved survival even with adjustment for lead time bias (“sustained” group HR 0.45, 95% CI 0.37, 0.55) and length time bias.

Conclusions

Sustained endoscopy was associated with earlier stage and improved survival. These results support the role of sustained surveillance in early detection of EAC.

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Acknowledgments

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

Funding

This study was funded by an American College of Gastroenterology Junior Faculty Development Grant awarded to L.C. Cummings. A.C. was supported by NIH Grants U54CA163060 (Case Barrett’s Esophagus Translational Research Network) and P50 CA150964 (Case GI SPORE). G.S.C. was supported by NIH Grant P50 CA150964 (Case GI SPORE), UL1 TR000439 (Case Clinical & Translational Science Collaborative), and P30 CA043703 (Case Comprehensive Cancer Center). M.S. was supported by P30 CA043703 (Case Comprehensive Cancer Center).

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Authors and Affiliations

  1. Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Mailstop 5066, Cleveland, OH, 44106-5066, USA

    Linda C. Cummings, Amitabh Chak & Gregory S. Cooper

  2. Case Comprehensive Cancer Center, 10900 Euclid Avenue, Cleveland, OH, 44106-7285, USA

    Linda C. Cummings, Amitabh Chak, Mark D. Schluchter, Seunghee Margevicius & Gregory S. Cooper

  3. Department of Medicine, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA

    Linda C. Cummings, Amitabh Chak & Gregory S. Cooper

  4. Department of Quantitative and Population Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA

    Tzuyung Doug Kou, Mark D. Schluchter & Seunghee Margevicius

Authors
  1. Linda C. Cummings
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  2. Tzuyung Doug Kou
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  3. Amitabh Chak
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  4. Mark D. Schluchter
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  5. Seunghee Margevicius
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  6. Gregory S. Cooper
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Correspondence to Linda C. Cummings.

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Cummings, L.C., Kou, T.D., Chak, A. et al. Receipt of Serial Endoscopy Procedures Prior to Esophageal Adenocarcinoma Diagnosis Is Associated with Better Survival. Dig Dis Sci 67, 1036–1044 (2022). https://doi.org/10.1007/s10620-021-06927-1

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  • DOI: https://doi.org/10.1007/s10620-021-06927-1

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