Post-endoscopy esophageal adenocarcinoma: Insights from a multicenter cohort in Colombia

INTRODUCTION: The incidence of esophageal adenocarcinoma (EAC) has increased. Although there are screening and surveillance programs, especially for patients with Barrett's esophagus (BE), they have limited effectiveness in detecting early disease. Post-endoscopy esophageal adenocarcinoma (PEEC), diagnosed after previous negative endoscopies, raises concerns about the accuracy of current endoscopic practices in high-risk patients. AIMS: Primary aim: to estimate the rate of PEEC and analyze its characteristics in patients at three hospital centers in Medellín, Colombia. SPECIFIC AIMS: • To compare characteristics between patients with PEEC and those diagnosed at the first endoscopy. • Evaluate the prevalence of BE in the two cohorts and its relation to PEEC. • Analyze the anatomic location of PEEC. MATERIALS AND METHODS: An observational cohort study was conducted that included 473 patients diagnosed with esophageal cancer between 2012 and 2023 at three centers in Medellín, Colombia, 31 of whom had PEEC. Their demographic, clinical, and survival data were evaluated using the STROBE guidelines for cohort studies (pages 22-26). RESULTS: The PEEC rate was 6.6%. Patients with PEEC presented with fewer alarm symptoms (35% vs 63%, p = 0.002), a higher prevalence of BE (42% vs 23%, p = 0.016), and were diagnosed at an earlier stage of disease. The previous endoscopies failed to detect lesions, especially in the proximal esophagus. CONCLUSIONS: PEEC is a frequent entity, especially in patients with BE and proximal lesions. Optimizing endoscopy through advanced imaging techniques and strict surveillance protocols is required.