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The Incidence of Esophageal Adenocarcinoma in a National Veterans Cohort With Barrett's Esophagus.
[esophageal adenocarcinoma]
OBJECTIVES
:
The
increasing
incidence
of
esophageal
adenocarcinoma
(
EA
)
in
the
United
States
may
have
leveled
off
in
recent
years
.
The
risk
of
EA
among
patients
with
Barrett
's
esophagus
(
BE
)
seems
to
be
decreasing
in
several
European
cohorts
,
but
these
estimates
are
unknown
in
the
United
States
.
We
aimed
to
determine
the
risk
of
developing
EA
in
a
national
cohort
of
BE
patients
in
the
US
Veterans
Health
Administration
and
to
account
for
the
use
of
endoscopic
ablation
and
esophagectomy
.
METHODS
:
This
was
a
retrospective
cohort
study
from
a
total
of
121
facilities
in
the
Veterans
Health
Administration
.
Veteran
patients
with
BE
diagnosed
between
1
October
2003
and
30
September
2009
were
included
and
followed
until
esophageal
cancer
diagnosis
,
death
or
30
September
2011
.
All
EA
diagnoses
were
verified
in
detailed
structured
reviews
of
medical
records
.
RESULTS
:
We
identified
29
,
536
patients
with
BE
who
met
our
eligibility
criteria
.
Most
were
men
(
96
.
9
%
)
and
White
(
83
.
2
%
)
,
with
a
mean
age
of
61
.
8
years
.
During
144
,
949
person-
years
of
follow-up
,
466
patients
developed
EA
,
yielding
an
incidence
rate
of
3
.
21
per
1
,
000
person-
years
(
95
%
confidence
interval
(
CI
)
2
.
94
-
3
.
52
)
.
Excluding
those
who
developed
EA
within
1
year
of
their
index
BE
date
lowered
the
incidence
rate
to
1
.
75
per
1
,
000
person-
years
.
However
,
including
additional
patients
who
underwent
endoscopic
ablation
or
esophagectomy
for
HGD
or
EA
increased
the
incidence
rate
to
4
.
79
(
95
%
CI
4
.
44
-
5
.
16
)
.
CONCLUSIONS
:
The
incidence
of
EA
in
a
US
national
cohort
of
mostly
male
veterans
may
be
lower
than
previous
estimates
.
Almost
half
of
the
EA
cases
were
diagnosed
within
1
year
of
their
BE
index
date
.
Am
J
Gastroenterol
advance
online
publication
,
21
October
2014
;
doi
:
10
.
1038
/
ajg
.
2014
.
324
.
Diseases
Validation
Diseases presenting
"several european cohorts"
symptom
esophageal adenocarcinoma
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