Barrett’s Oesophagus Surveillance versus endoscopy at need Study (BOSS): a randomized controlled trial

IF 25.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterology Pub Date : 2025-04-01 DOI:10.1053/j.gastro.2025.03.021

Oliver Old, Janusz Jankowski, Stephen Attwood, Clive Stokes, Catherine Kendall, Cathryn Rasdell, Alex Zimmermann, M Sofia Massa, Sharon Love, Scott Sanders, Manuela Deidda, Andrew Briggs, Julie Hapeshi, Chris Foy, Paul Moayyedi, Hugh Barr

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Abstract

Background and aims

Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma (EA). Surveillance endoscopy aims to detect early malignant progression: though widely practised it has not previously been tested in a randomized trial.

Methods

BOSS was a randomized controlled trial at 109 centres in the UK. Patients with BE were randomized to two-yearly surveillance endoscopy or ‘at need’ endoscopy, offered only for symptoms. Follow up was a minimum of 10 years. The primary outcome was overall survival in the intention-to-treat population. Secondary outcomes included cancer-specific survival; time to diagnosis of EA; stage of EA at diagnosis; frequency of endoscopy and serious adverse events related to interventions.

Results

3453 patients were recruited. 1733 patients were randomized to surveillance and 1719 to ‘at need’ endoscopy. Median follow up time was 12·8 years for the primary outcome. There was no evidence of a difference in overall survival between surveillance (333 deaths in 1733 patients) versus ‘at need’ arms (356 deaths in 1719 patients), hazard ratio 0·95 (95% CI 0·82-1·10), stratified log-rank p=0·503). There was no evidence of a difference for surveillance versus ‘at need’ endoscopy in cancer-specific survival (108 vs. 106 deaths from any cancer, HR 1·01 (95% CI 0·77-1·33), p=0·926), time to diagnosis of EA (40 vs. 31 patients had a diagnosis of EA, HR 1·32 (95% CI 0·82-2·11), p=0·254), or cancer stage at diagnosis. 8 (0·46%) surveillance patients and 7 (0·41%) ‘at need’ patients reported serious adverse events.

Conclusion

Surveillance did not improve overall survival or cancer-specific survival. ‘At need’ endoscopy may be a safe alternative for low-risk patients.

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来源期刊

Gastroenterology 医学-胃肠肝病学

CiteScore

45.60

自引率

2.40%

发文量

4366

审稿时长

26 days

期刊介绍： Gastroenterology is the most prominent journal in the field of gastrointestinal disease. It is the flagship journal of the American Gastroenterological Association and delivers authoritative coverage of clinical, translational, and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. Some regular features of Gastroenterology include original research studies by leading authorities, comprehensive reviews and perspectives on important topics in adult and pediatric gastroenterology and hepatology. The journal also includes features such as editorials, correspondence, and commentaries, as well as special sections like "Mentoring, Education and Training Corner," "Diversity, Equity and Inclusion in GI," "Gastro Digest," "Gastro Curbside Consult," and "Gastro Grand Rounds." Gastroenterology also provides digital media materials such as videos and "GI Rapid Reel" animations. It is abstracted and indexed in various databases including Scopus, Biological Abstracts, Current Contents, Embase, Nutrition Abstracts, Chemical Abstracts, Current Awareness in Biological Sciences, PubMed/Medline, and the Science Citation Index.