title: Risk of upper gastrointestinal cancers in patients with gastroesophageal reflux disease after a negative screening endoscopy.
abstract: OBJECTIVE
  Practice guidelines recommend a 1-time screening endoscopy for patients with gastroesophageal reflux disease (GERD) who are at high risk for Barrett's esophagus or malignancy. However, little is known about the risk of cancer in patients with negative findings from screening endoscopies.
  
  
  METHODS
  We conducted a retrospective cohort study using data from 121 Veterans Health Administration facilities nationwide to determine the incidence rate of esophageal adenocarcinoma (EA) separately, as well as any upper gastrointestinal cancers, in patients with an initial negative screening endoscopy (esophagogastroduodenoscopy [EGD]). We included veteran patients with GERD diagnosed between 2004 and 2009 who had a negative screening EGD within 1 year of diagnosis. We estimated the incidence rate of EA, and any upper gastrointestinal cancer, in patients with GERD who had a negative screening EGD. We examined differences in demographic, clinical, and facility factors among patients with and without cancer.
  
  
  RESULTS
  We identified 68,610 patients with GERD and a negative screening EGD (mean age, 55.5 y; 90% men; 67.5% white). During a mean follow-up period of 3.2 years, 10 patients developed EA and 29 patients developed any upper gastrointestinal malignancies, including EA. The incidence of subsequent EA in this group was 4.6/100,000 patient-years of follow-up evaluation, whereas the incidence of any upper gastrointestinal cancers was 13.2/100,000 patient-years of follow-up evaluation. Patients with a subsequent cancer were significantly older and had higher comorbidity scores than patients without cancer. Other clinical and facility factors did not differ significantly between these 2 groups.
  
  
  CONCLUSIONS
  The risk of cancer is low, over a mean 3-year period, for patients with GERD who had a negative screening endoscopy. These findings justify recommendations for a 1-time screening endoscopy for patients with GERD.
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Shakhatreh
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Duan
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Avila
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hinojosa-Lindsey
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas.
authors.forename: John
authors.initials: J
authors.lastname: Chen
authors.affiliation: Section of Health Services Research, Houston Veterans Affairs Health Services Research and Development Center of Excellence, Houston, Texas; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas. Electronic address: hasheme@bcm.edu.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013781:Texas
keywords: Cancer; Endoscopy; GERD; Incidence