Update on AspECT in Northern Ireland

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Introduction

Barrett’s oesophagus is a recognised precancerous lesion. AspECT (Aspirin and Esomeprazole Chemoprevention Trial of Oesophageal Cancer in patients with Barrett’s oesophagus) started recruitment in 2005. It is a randomised 4×4 comparison of high dose PPI 40 mg BD Esomeprazole vs 20 mg OD and aspirin 300 mg OD vs no aspirin. The end point is high grade dysplasia (HGD)/cancer.

Methods

Recruitment closed in 2009 with 2506 Barrett’s patients in the UK and 302 (12%) of these in NI. There were 242 males, 60 females age range 23 – 81 mean 54. The aim is to follow each patient for up to 10 years with 2 yearly endoscopy and is due to finish in 2017.

Results

12 patients have completed 10 years and all have completed 6 years. 11 have died of non-oesophageal cancer related causes and 26 are lost to follow up. 12 developed HGD/cancer (4% overall or 0.47% per patient years of follow up) at 1 month to 9 years (mean 3.4). There were 8 males (3% of males) and 4 females (6.5%). The lengths of Barrett’s ranged from 2-10cms and all were specialised intestinal metaplasia. Low grade dysplasia preceded HGD/cancer in 6. One had oesophagectomy and the rest endoscopic treatment. All are disease free at follow up.

Conclusion

HGD/cancer developed in this cohort at a higher rate than some recent epidemiological studies, possibly because of careful follow up and all were successfully treated. The effects if any of chemoprevention await publication of the full study.