Upper GI Screening Endoscopy in Individuals With a Family History of Barrett’s Esophagus or Esophageal Cancer
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Upper GI Screening Endoscopy in Individuals With a Family History of Barrett’s Esophagus or Esophageal Cancer

Prateek Sharma, MD, FASGE, reviewing Peters Y, et al. Aliment Pharmacol Ther 2021 Aug 12.

The incidence of esophageal adenocarcinoma (EAC) continues to increase and is still associated with a poor prognosis with a 5-year survival rate of 20%. The majority of EAC cases are found during index endoscopic screening of the upper GI tract; therefore, screening for EAC and its precursor lesion, Barrett’s esophagus (BE), could potentially impact EAC rates. 

This systematic review included 14 studies of endoscopic and pathologically confirmed cases of BE or EAC in patients with a positive family history (N=16,189). The overall pooled prevalence of family history was higher in patients with BE (8.8%; 95% confidence interval [CI], 5.5%-13.8%; I2=76%; 6 studies) than patients with EAC (4.4%; 95% CI, 2.2%-8.7%; I2=75%; 7 studies). When first-degree relatives of patients with BE underwent endoscopic screening, the yield for BE was between 12% and 44% (4 studies) but was low for high-grade dysplasia and EAC (<2%). Finally, individuals with a family history had a higher risk of being diagnosed with BE (adjusted relative risk [aRR], 3.26; 95% CI, 1.43-7.40) and EAC (aRR, 2.19; 95% CI, 1.14-4.21) compared with individuals without a family history.

Prateek Sharma, MD, FASGE

COMMENT

This systematic review shows that confirmed familial clustering is seen in 10% of individuals with BE and/or EAC. Individuals with a first-degree relative with BE and/or EAC are 2 to 3 times more likely than individuals without a family history to have BE and/or EAC. Individuals with 2 or more family members with confirmed BE or EAC should be offered screening.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Peters Y, van Grinsven E, Siersema PD. Systematic review with meta-analysis: the effects of family history on the risk of Barrett’s oesophagus and oesophageal adenocarcinoma. Aliment Pharmacol Ther 2021 Aug 12. (Epub ahead of print) (https://doi.org/10.1111/apt.16558)

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