Antireflux Surgery Does Not Prevent Cancer in Patients With Barrett’s Esophagus
Prateek Sharma, MD, FASGE, reviewing Åkerström JH, et al. Gastroenterology 2024 Jan.
The extent to which antireflux surgery offers protection against esophageal adenocarcinoma (EAC) compared to antireflux medication in individuals with Barrett’s esophagus (BE) remains uncertain. This study was a population-based cohort study of patients with BE from Denmark, Finland, Norway, and Sweden, followed for as many as 32 years.
In this study involving 33,939 patients with BE, 1.6% had undergone antireflux surgery. The overall hazard ratio (HR) did not decrease for patients who had undergone antireflux surgery compared with those using antireflux medication and, instead, increased (adjusted HR, 1.9; 95% confidence interval [CI], 1.1-3.5) during follow-up. Interestingly, HRs did not exhibit a decreasing trend with longer follow-up periods. For instance, the HR was 1.8 (95% CI, 0.6-5.0) during the first 4 years of follow-up and escalated to 4.4 (95% CI, 1.4-13.5) after 10 years of follow-up.
COMMENT
Antireflux surgery does not lower the chance of developing esophageal adenocarcinoma more than using antireflux medication in individuals with Barrett’s esophagus.
Prateek Sharma, MD, FASGE
CITATION
Åkerström JH, Santoni G, von Euler Chelpin M, et al. Antireflux surgery versus antireflux medication and risk of esophageal adenocarcinoma in patients with Barrett's esophagus. Gastroenterology. 2024;166:132-138.e3. (https://doi.org/10.1053/j.gastro.2023.08.050)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.