Effect of a prior endoscopy on outcomes of esophageal adenocarcinoma among United States veterans

Background: The efficacy of screening and surveillance EGD for esophageal adenocarcinoma (EAC) is controversial. Objective: To examine the effect of an EGD before the diagnosis of EAC on survival after the diagnosis of cancer among patients with gastroesophageal reflux (GER). Design: A retrospective, controlled cohort study. Subjects: The national administrative databases of the Veterans Affairs were accessed, and patients diagnosed with EAC, from 1995 through 2003, who had a prior diagnosis consistent with GER were identified. Electronic medical records were then abstracted. Cases were subjects who had an EGD performed between 1 and 5 years before the diagnosis of EAC; controls were those subjects without a prior EGD. Results: A total of 155 subjects with EAC and GER were identified. Cases with a history of an EGD at least I year before a diagnosis of EAC (n = 25) were diagnosed at earlier stages than those without a prior EGD (P = .02) but did not experience a significant improvement in survival (adjusted hazard ratio 0.93 [95% CI, 0.58-1.50]). Cases who had been enrolled in surveillance programs that adhered to published guidelines trended toward improved survival, but long-term survival reverted toward the rate found without any surveillance. Conclusions: A prior EGD was associated with an improved stage at the diagnosis of EAC but did not alter long-term survival. In the absence of prospective, randomized, controlled trials, the benefit of screening and surveillance to decrease mortality from EAC cannot be confirmed. (Gastrointest Endosc 2008;68:849-55.)