August 7, 2025

Tackling Prevention and Early Diagnosis of Esophageal Adenocarcinoma through a National Barrett’s Registry and Scientific Network

NRNicola RafteryNational College of Ireland JEJessie A. ElliottTrinity Health CMCian MuldoonNational College of Ireland

Key Points

Main finding revealed progression rates to esophageal adenocarcinoma from Barrett's esophagus in a large cohort.
Key evidence indicates a combined incidence of 2.42% for HGD and EAC yearly in a structured Barrett's program.
Approach utilized multivariable regression models and quality-assured endoscopy for accurate risk assessment.
Significance underlines the effectiveness of targeted prevention and early detection strategies in esophageal cancer.

Abstract

To evaluate the progression rate of Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) using a prospectively maintained national registry, quality-assured endoscopy and expert pathology. BE is the sole pathologic precursor of EAC. Targeting prevention and early diagnosis through quality-assured BE programs has a compelling rationale. A Barrett's Registry and Bioresource was founded in 2011, and data to November 2024 was prospectively documented in a web-based system (Dendrite, UK). Endoscopy and pathology (of specialized intestinal metaplasia) were strictly quality assured per current guidelines. Expert gastrointestinal pathologists classified non-dysplastic BE (NDBE), indefinite for dysplasia (IND), low-grade dysplasia (LGD), and high-grade dysplasia (HGD). Endoscopic eradication therapies were monitored. Multivariable regression models evaluated risk factors for progression, and Kaplan-Meier curves were constructed for overall progression, and progression excluding the first year following the index biopsy. 9,436 patients were registered, with a median follow up of 4.4y, and 5,331 had at least one follow-up endoscopy. Overall, 252 cases (4.7%, 95% CI 1.70-2.18) of HGD and 255 cases (4.7%, 95% CI 1.72-2.20) of EAC were diagnosed. Among these, 150 cases (2.8%. 95% CI 1.05-1.44) of HGD and 148 (2.7%, 95% CI 1.05-1.44) of EAC were diagnosed more than one year after the index endoscopy. The overall incidence of HGD/EAC combined was 2.42%(95% CI 2.14-2.73), 6.59%(95% CI 5.14-8.46), and 13.79%(95% CI 11.94-15.93) per year in NDBE, IND and LGD, respectively. Independent risk factors include male gender (HR 0.655,95% CI 0.56-0.896,P<0.004), age (HR 1.027, 95% CI 1.02-1.04,P<0.001) and Barrett's length (HR 1.635,95% CI 1.33-2.01,P<0.001). 604 (6.4%) patients underwent RFA, with a complete eradication of SIM in 80.5% and 10 (1%) patients required resectional surgery. Cancer specific survival in the total cohort was 100%. A structured high volume Barrett's program, underpinned by quality assurance, provides data that highlights a strategy that provides proof of concept in targeting prevention and early detection, and is anticipated to reduce mortality.

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