Original ResearchRisk of oesophageal adenocarcinoma in individuals with Barrett's oesophagus

•Nationwide, population-based cohort study of 7932 patients with Barrett's oesophagus.•Two thirds of all oesophageal cancer were diagnosed within the first year of Barrett.•After the first year, the annual risk of oesophageal adenocarcinoma was 0.15%.•Ninety-seven per cent of oesophageal adenocarcinomas arose in undiagnosed Barrett's.

IntroductionRecent studies have indicated a lower incidence rate of oesophageal adenocarcinoma (OAC) in individuals with Barrett's oesophagus (BO) than most earlier studies. Our objective was to assess the risk of OAC in a Swedish unselected cohort of individuals with BO.MethodsThis population-based cohort study included all Swedish residents diagnosed with BO in 2006-2013, identified through the Swedish Patient Registry. The cohort members were followed from the date of first BO diagnosis until the first occurrence of OAC, high-grade dysplasia (HGD), death, emigration or end of study period. The main outcome was incidence rates with 95% confidence intervals (CIs) of OAC.ResultsAmong 7932 participants with BO and 18,415 person-years of follow-up, the overall incidence of OAC was 1.47 (95% CI 0.91-2.02) per 1000 person-years. When stratified into follow-up periods after BO diagnosis, the incidence rate of OAC was 15.53 (4.77-26.29) from 7 to 30 d, 4.10 (0.82-7.38) from 31 to 100 d, 1.87 (0.00-3.99) from 101 d to 6 months, 1.44 (0.18-2.70) from >6 months to 1 year, 0.94 (0.36-1.53) from >1 year to 3 years and 2.17 (1.14-3.21) from >3 years to the end of follow-up. The median follow-up time was 2.13 person-years.ConclusionThis population-based study indicates that OAC is primarily diagnosed during the first months following an initial diagnosis of BO. This could justify a changed surveillance strategy of BO with a repeated thorough endoscopy shortly after initial BO diagnosis to identify prevalent early OAC or HGD.