Development of oesophageal adenocarcinoma in Barrett's oesophagus in the ACT - does following surveillance guidelines save lives in the community?

Abstract

Background: It has been shown that patients in the ACT with Barrett's oesophagus (BO) do not necessarily undergo surveillance according to accepted guidelines. Objective: To identify patients in the ACT with BO who developed oesophageal adenocarcinoma (OA) and did not receive surveillance in accordance with the Cancer Council Australia guidelines, and to assess mortality for these patients. Method: Patients diagnosed with BO and OA were identified using endoscopic biopsy reports from both Capital Pathology and ACT Pathology laboratories for the period 1/01/1999 to 15/12/2014 (approximately 16 years). These patients were categorised according to: 1) diagnosed with OA and BO simultaneously; 2) OA patients who had a previous BO diagnosis but did not receive surveillance according to guidelines; and 3) patients who underwent adequate surveillance but still progressed to OA. Mortality was then assessed from patient records. Results: One hundred ninety-three ACT patients with a diagnosis of both OA and BO were identified over the 16-year period. The male to female ratio was 4:1 and the mean age of OA diagnosis was 67 years. Nineteen patients (9.8%) patients received inadequate BO surveillance and progressed to OA; 13 patients (6.7%) received adequate BO surveillance but still progressed to OA; but the majority (83.4%) presented with a simultaneous diagnosis of BO and OA. Of the 19 who received inadequate surveillance, 9 are deceased, 7 are alive and 3 unknown. Of the 13 patients who received adequate surveillance and progressed to OA, 7 are deceased, 4 alive and 2 unknown. Conclusion: Over the 16-year time period, 193 patients with BO developed OA in the ACT, the majority presenting with an established diagnosis of OA. Despite 19 patients with known BO not receiving adequate surveillance, the mortality data was similar to those who had appropriate surveillance. This raises questions as to the effectiveness of surveillance in the community and the validity of the Cancer Council guidelines regarding the recommended time intervals for endoscopy.