Endoscopic surveillance for Barrett's esophagus (BE) could reasonably be discontinued at age 80 in men and 75 in women — and earlier in patients with significant comorbidities — according to a population-based analysis of more than 38,000 newly diagnosed patients across four Nordic countries presented at Digestive Disease Week® (DDW) 2026. The findings, from the NordBEST2 study, provide real-world validation for cutoffs proposed by an earlier modeling study and were derived by comparing annual incidence of esophageal adenocarcinoma (EAC) with annual mortality from non-EAC causes across strata of age, sex, and comorbidity level.
In men without comorbidity, the ratio of non-EAC to EAC mortality was approximately 8.5 at age 73 and exceeded 10 by age 81. In men with severe comorbidity, the ratio exceeded 30. The study analyzed 38,608 patients with 207,369 person-years of follow-up (median 4.8 years) for mortality outcomes, with EAC incidence assessed in 34,057 patients followed a median of 5.4 years.
“Current recommendations do not account for competing mortality, which considers the risk of mortality that is unrelated to esophageal adenocarcinoma,” Sachin Wani, MD, professor of medicine at the University of Colorado Anschutz Medical Campus, Aurora, told GI & Hepatology News. “This is a key variable in decisions for endoscopic surveillance. If it is determined that mortality risk unrelated to EAC is substantial and exceeds EAC risk, this could potentially offset benefits of surveillance. Most physicians make future surveillance decisions heavily based on perceived risk for EAC without considering risks or life expectancy.”
Current clinical guidelines recommend regular endoscopic monitoring of BE to detect progression to EAC but do not specify when surveillance should stop. To address this gap, Wani and his team analyzed data from national diagnosis, procedure, cancer, and cause-of-death registries in Denmark, Finland, Norway, and Sweden from 2006 to 2023. Patients were followed until death or end of the study period. The researchers calculated annual incidence rates for EAC and annual mortality rates for EAC and non-EAC causes per 1,000 person-years, then reported these across unique combinations of age (69-81 years), sex, and comorbidity level (none, mild, moderate, or severe).
The cohort had a median age of 65 years at BE diagnosis, and 33% were women. During follow-up, 7,461 patients (19.3%) died, with 287 deaths (0.7% of the full cohort) attributed to EAC. Among patients analyzed for cancer incidence, 358 (1.1%) developed EAC.
While EAC incidence rose modestly with age, non-EAC mortality climbed much more steeply, particularly in older patients and those with significant comorbidities. Non-EAC mortality in men without comorbidity increased from 26 to 73 per 1,000 person-years between ages 73 and 81. EAC mortality, by contrast, was comparable across comorbidity levels and increased only slightly with age. Patterns were similar in women, though absolute rates differed.
Based on these data, the authors concluded that surveillance could reasonably be stopped at age 80 in men and 75 in women, with earlier discontinuation in patients with severe comorbidities — age 73 for men and 69 for women.
“These results should serve as a call to the entire GI and medical community to consider a personalized approach to surveillance that mitigates the risk of EAC while factoring in competing mortality,” Wani said. “We hope that using this strategy will reduce the harms of surveillance endoscopy and improve the overall cost-effectiveness of surveillance strategies.”
Dr. Wani disclosed consulting relationships with Lucid Diagnostics, Boston Scientific, Exact Sciences, Enterotracker, Cyted, and Castle Biosciences, and research grant funding from Lucid Diagnostics, CDx Diagnostics, Cyted, and Exact Sciences.
DDW is AGA's annual meeting, jointly sponsored by AGA, AASLD, ASGE, and SSAT. Learn more at ddw.org.