Chronic GERD and risk of esophageal adenocarcinoma: Should we screen with gastroscopy?
Abstract
© 2020 Joule Inc. or its licensors CMAJ | JULY 6, 2020 | VOLUME 192 | ISSUE 27 E781 A new guideline by the Canadian Task Force on Preventive Health Care recommends against screening all patients with chronic gastroesophageal reflux disease (GERD) for esophageal adenocarcinoma.1 Although the guideline was robustly developed, its strong recommendation against gastroscopy screening is based on very low-quality evidence, which warrants discussion. The guideline developers looked at 3 main outcome measures in the systematic review of esophageal screening studies that informed their recommendations: decrease in mortality, detection of esophageal adenocarcinoma at an earlier stage and detection of treatable precancerous conditions, such as Barrett esophagus or dysplasia, resulting in improved outcomes. They found a single small retrospective study of 155 patients, which showed that screening was associated with cases of esophageal adenocarcinoma being diagnosed at an earlier stage, but showed no survival benefit.2 A second retrospective study of 153 patients did not provide meaningful data on the outcomes of interest.1 The new guideline’s recommendation against gastroscopy screening does not apply to patients with alarm symptoms such as dysphagia, evidence of upper gastrointestinal bleeding, weight loss and vomiting. Nor does it apply to patients who receive a diagnosis of Barrett esophagus, which requires that gastroscopy and histology must have been performed in the past. Such…
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