Esophageal cancer occurs in 7/1000 per year

Clinical Question

How many patients with Barrett's esophagus will develop esophageal cancer?

Bottom Line

Approximately 7 per 1000 (0.7%) patients with Barrett's esophagus will develop esophageal cancer per year. The low incidence of Barrett's, followed by this low incidence of esophageal cancer, may make routine evaluation of patients with chronic gastroesophageal reflux less important. (LOE = 1b-)


Thomas T, Abrams KR, De Caestecker JS, Robinson RJ. Meta analysis: cancer risk in Barrett's oesophagus. Aliment Pharmacol Ther 2007;26(11-12):1465-1477.  [PMID:17900269]

Study Design

Meta-analysis (other)


Self-funded or unfunded


Various (meta-analysis)


Barrett's esophagus is a premalignant condition, increasing the risk of esophageal cancer as compared with the general population. This meta-analysis consisted of studies written in English that, following identification of Barrett's with or without intestinal metaplasia, followed these patients up to determine their likelihood of developing subsequent esophageal cancer. The authors searched 2 databases (using 2 search engines to search MEDLINE) and references from retrieved articles, identifying 41 studies for inclusion. Eighteen of the studies were retrospective and 23 were prospective. One author abstracted the data and 2 authors independently reviewed the articles for inclusion. Overall, they found no publication bias. Finding heterogeneity among the studies, the authors appropriately evaluated the results using a random effects model, pooling the data from the individual studies. The prevalence (the number of people with esophageal cancer) was 4% in 7000 patients; high-grade dysplasia was present in 1%. The overall incidence (new cases per year) was 7 per 1000 (95% CI, 6-9). The incidence did not vary by country. The only significant confounder was the presence of complicated Barrett's.