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Over the last several decades, the incidence of esophageal adenocarcinoma has increased, which has driven the recommendation to screen patients with Barrett's esophagus, a premalignant condition, for high-grade dysplasia (HGD) and cancer. Despite these efforts, HGD and cancer may be missed on upper endoscopy.

The term "post-endoscopy esophageal adenocarcinoma (PEEC)" describes esophageal cancer (or HGD) identified within 1 year of a non-diagnostic upper endoscopy.

A systematic review and meta-analysis, recently published in , aims to explain the epidemiology of PEEC and the incidence of PEEC among adults with Barrett's esophagus. After performing a literature search, Sawas et al. were able to include 52 studies with an average follow-up of about 5 years that reported outcomes on over 145,000 patients with Barrett's esophagus. They found that PEEC accounts for almost one out of four of all HGD/esophageal adenocarcinoma cases, highlighting the large burden of missed lesions on upper endoscopy.

Additionally, the proportion of PEEC was higher in studies published in the last 5 years, indicating the contemporary importance of PEEC. Clinically, this study is important because it highlights the need for improvements in our current Barrett's esophagus surveillance programs.

Additional research is needed to determine if there are other factors that influence PEEC, such as the training of the endoscopist or the volume of the surveillance center.

Michelle Long, MD, is an assistant professor of medicine in the department of medicine, section of gastroenterology, at Boston University School of Medicine in Boston, Massachusetts.

You can read an interview with two of the study's authors here, and the abstract of the study here.