Endoscopic Therapy for Barrett’s Esophagus with Low-grade Dysplasia: The SURVENTTrial

September 2020 Council

Lead Division/Office

DDN

Point(s) of Contact

Frank Hamilton, M.D., M.P.H.

Executive Summary

Barrett’s esophagus (BE), a replacement of the normal squamous epithelium of the esophagus by columnar lined epithelium with intestinal metaplasia, is a complication of gastroesophageal reflux disease (GERD) and the only identifiable risk factor for esophageal adenocarcinoma (EAC). BE is remarkably common in the U.S., with an estimated prevalence in adult Americans from 1.7-5.6% and an incidence rate of 23-32 per 100,000 person-years.

Furthermore, EAC is one of the most rapidly increasing cancers in the United States, frequently presenting at an advanced stage and associated with a dismal 5-year survival rate. Endoscopic eradication therapy (EET) is the standard of care for patients with BE and high-grade dysplasia (HGD) or mucosal EAC.

However, the presence of clinical equipoise and the importance of this question indicates that a need for a trial of endoscopic surveillance versus EET in this patient population is an urgent, unmet gap in our current knowledge regarding treatment of this common condition.