Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair - a systematic review
Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair - a systematic review
Background: concern exists that patients born with oesophageal atresia (OA) may be at high risk for Barrett’s oesophagus (BO), a known malignant precursor to the development of oesophageal adenocarcinoma. Screening endoscopy has a role in early BO identification but is not universal in this population. This study aimed to determine prevalence of BO, following OA repair surgery, to quantify the magnitude of this association and inform the need for screening and surveillance.
Method: a systematic review, undertaken according to PRISMA guidelines, was pre-registered on PROSPERO (CRD42017081001). PubMed and EMBASE were interrogated using a standardized search strategy on 31/7/20. Included papers, published in English, reported either: one or more cases of either BO (gastric/intestinal metaplasia) or oesophageal cancer in patients born with OA; or long term (>2 years) follow-up after OA surgery with or without endoscopic screening or surveillance.
Results: 134 studies were identified including 19 case reports/ series and 115 single or multi-centre cohort studies. There were 13 cases of oesophageal cancer (9 squamous cell, 4 adenocarcinoma) with a mean age at diagnosis was 40.5 years (range 20-47). From 6282 patients under long-term follow-up, 317 patients with BO were reported. Overall prevalence of BO was 5.0% (95%CI 4.5-5.6%)with a mean age at detection of 13.8 years (range 8 months–56 years). Prevalence of BO in series reporting long-term endoscopic follow-up was 12.8% (95%CI 11.3-14.5%).
Conclusion: despite a limited number of cancers, the prevalence of BO in patients born with OA is relatively high. While limited by the quality of available evidence, this review suggests endoscopic screening and surveillance may be warranted but uncertainties remain over the design and effectiveness of any putative programme.
Tullie, Lucinda
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Kelay, Arun
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Bethell, George S.
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Major, Christina
cb49182f-743f-4904-84ad-a4f064c9d150
Hall, Nigel
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5 August 2021
Tullie, Lucinda
7674c530-00bc-462f-a4c3-a567f1022f26
Kelay, Arun
384c2be7-e84b-4522-8650-992e2f3ab7f5
Bethell, George S.
9c442b15-1e62-4b7a-8334-85024c37ecc2
Major, Christina
cb49182f-743f-4904-84ad-a4f064c9d150
Hall, Nigel
6919e8af-3890-42c1-98a7-c110791957cf
Tullie, Lucinda, Kelay, Arun, Bethell, George S., Major, Christina and Hall, Nigel
(2021)
Barrett’s oesophagus and oesophageal cancer following oesophageal atresia repair - a systematic review.
British Journal of Surgery, 5 (4).
(doi:10.1093/bjsopen/zrab069).
Abstract
Background: concern exists that patients born with oesophageal atresia (OA) may be at high risk for Barrett’s oesophagus (BO), a known malignant precursor to the development of oesophageal adenocarcinoma. Screening endoscopy has a role in early BO identification but is not universal in this population. This study aimed to determine prevalence of BO, following OA repair surgery, to quantify the magnitude of this association and inform the need for screening and surveillance.
Method: a systematic review, undertaken according to PRISMA guidelines, was pre-registered on PROSPERO (CRD42017081001). PubMed and EMBASE were interrogated using a standardized search strategy on 31/7/20. Included papers, published in English, reported either: one or more cases of either BO (gastric/intestinal metaplasia) or oesophageal cancer in patients born with OA; or long term (>2 years) follow-up after OA surgery with or without endoscopic screening or surveillance.
Results: 134 studies were identified including 19 case reports/ series and 115 single or multi-centre cohort studies. There were 13 cases of oesophageal cancer (9 squamous cell, 4 adenocarcinoma) with a mean age at diagnosis was 40.5 years (range 20-47). From 6282 patients under long-term follow-up, 317 patients with BO were reported. Overall prevalence of BO was 5.0% (95%CI 4.5-5.6%)with a mean age at detection of 13.8 years (range 8 months–56 years). Prevalence of BO in series reporting long-term endoscopic follow-up was 12.8% (95%CI 11.3-14.5%).
Conclusion: despite a limited number of cancers, the prevalence of BO in patients born with OA is relatively high. While limited by the quality of available evidence, this review suggests endoscopic screening and surveillance may be warranted but uncertainties remain over the design and effectiveness of any putative programme.
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BJS Open-0059 22.06
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Table 1 13.6.21
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Table 2 13.6.21
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Appendix 1 30.12
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Appendix 2 LT update 30.12
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Accepted/In Press date: 17 June 2021
e-pub ahead of print date: 1 July 2021
Published date: 5 August 2021
Identifiers
Local EPrints ID: 449996
URI: http://eprints.soton.ac.uk/id/eprint/449996
ISSN: 0007-1323
PURE UUID: f427fcd5-29be-4133-b62f-78895f07342c
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Date deposited: 02 Jul 2021 16:30
Last modified: 17 Mar 2024 03:24
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Author:
Lucinda Tullie
Author:
Arun Kelay
Author:
George S. Bethell
Author:
Christina Major
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