Increased detection rates of Barrett's oesophagus without rise in incidence of oesophageal adenocarcinoma.
OBJECTIVE
The incidence of oesophageal adenocarcinoma has quadrupled in the last 20 years. Barrett's oesophagus carries a 30- to 125-fold increased risk of developing adenocarcinoma. The purpose of this study was to evaluate the incidence and surveillance of Barrett's oesophagus, dysplasia and adenocarcinoma in Eastern Switzerland.


METHODS
Histological reports of 3659 patients (5190 oesophageal biopsies) from the St. Gallen Institute of Pathology were searched for evidence of Barrett's oesophagus (period 1989-1999). After retrospective classification according to findings on endoscopy and histology, the data were analysed with regard to surveillance intervals and incidence rates of Barrett's oesophagus, dysplasia and adenocarcinoma.


RESULTS
742 patients with Barrett's oesophagus and 100 with oesophageal adenocarcinoma were identified and followed up for a mean 1.6 (1-11) years. The average incidence of Barrett's oesophagus rose from 8.5/10(5)/yr (CI-95%: 7.4-9.7) in the first to 15.5/10(5)/yr (CI-95% 14.0-17.0) in the second 5-year period. The incidence of adenocarcinoma in our study population was 0.5% (1/97 patient years). In 207 patients (25%) with follow-up of >1 year, 9% progressed to low grade and 1% to high grade dysplasia, and 5% to adenocarcinoma. Adequacy of surveillance in BE patients rose from 54% to 87% over the study period.


CONCLUSIONS
There is an increasing incidence of Barrett's oesophagus, which is not accompanied by an increase in oesophageal adenocarcinoma, in Eastern Switzerland. Surveillance of Barrett's oesophagus is often inadequate in spite of relevant findings such as dysplasia.
Hurschler
Daniel
D
Division of Gastroenterology, Kantonsspital St. Gallen, Switzerland.
Borovicka
Jan
J
Neuweiler
Joerg
J
Oehlschlegel
Christian
C
Sagmeister
Markus
M
Meyenberger
Christa
C
Schmid
Ulrico
U
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology; D001706:Biopsy / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D004945:Esophagoscopy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011787:Quality of Health Care; D012189:Retrospective Studies; D012306:Risk; D013557:Switzerland / Q000453:epidemiology