Predicting the Risk of Esophageal Adenocarcinoma in People With Barrett Esophagus

CLINICAL QUESTION

In patients with Barrett esophagus, what is the annual risk of developing invasive esophageal adenocarcinoma?

EVIDENCE SUMMARY

In Western countries, the prevalence of Barrett esophagus in adults is estimated to be 1% to 2% and, of those, about one-third have long-segment (greater than 2 cm) disease.¹ Risk factors for Barrett esophagus include gastroesophageal reflux disease (GERD), male sex, age older than 50 years, tobacco use, and obesity. Alcohol is not associated with the development of Barrett esophagus, and some studies have shown a protective effect.^2,3 In patients with Barrett esophagus, approximately 0.1% to 0.4% of cases progress to esophageal adenocarcinoma each year. Risk factors for progression include the presence of dysplasia (especially higher grade), a longer segment of Barrett esophagus, and a longer duration of Barrett esophagus.¹

Guidelines from the American College of Gastroenterology (ACG) and the European Society for Gastrointestinal Endoscopy recommend surveillance for esophageal adenocarcinoma in people with Barrett esophagus. Although more frequent upper endoscopy screening intervals are recommended for those with dysplasia, a 5-year interval is recommended for patients with less than a 3-cm segment of Barrett esophagus without dysplasia, and a 3-year interval for those with a longer segment and no dysplasia.^4,5 A risk score that identifies patients at low, intermediate, and high risk for progressing to esophageal adenocarcinoma could help physicians allocate patients to lower vs higher intensity surveillance protocols.