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Risk of Upper Gastrointestinal Cancers in Patients With Gastroesophageal Reflux Disease After a Negative Screening Endoscopy.
[esophageal adenocarcinoma]
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
.
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
.
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
.
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
.
Diseases
Validation
Diseases presenting
"in patients with an initial negative screening endoscopy"
symptom
esophageal adenocarcinoma
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