Motion - All patients with GERD should be offered once in a lifetime endoscopy: arguments against the motion.
The evidence for the recommendation that patients with gastroesophageal reflux disease (GERD) be offered once in a lifetime endoscopy is weak and is not supported by any clinical trials. GERD is a very prevalent condition, yet only 10% of patients with GERD have Barrett's esophagus (BE). Esophageal adenocarcinoma (EAC) is a rare condition and is uncommon even among patients with BE. A decision analysis found that surveillance of BE patients is performed because of inflated estimates of the rate of progression from BE to EAC. Dysplasia more often regresses to more benign histological findings than to cancer, and transient dysplasia can also lead to a high rate of unnecessary endoscopy. Even though practice guidelines about endoscopic surveillance have been published, there is no consensus among gastroenterologists about appropriate protocols, and many physicians are more aggressive than the guidelines. It has not been proved that surveillance saves lives, in part because BE rarely leads to death from EAC. The favourable results from some specialized centres may not be widely applicable. The recommendation for 'once in a lifetime' endoscopy for GERD patients is premature.
Freston
James W
JW
University of Connecticut Health Center, Farmington, Connecticut 06030-1111, USA. freston@nso.uchc.edu
D016145:Endoscopy, Digestive System / Q000191:economics; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000191:economics; D006287:Health Planning Guidelines