Esophageal Adenocarcinoma in a First Degree Relative Increases the Risk for Progression to Esophageal Adenocarcinoma in Patients With Barrettʼs Esophagus: 2017 Fellows-in-Training Award (Esophagus Category): 309

Introduction: Esophageal adenocarcinoma (EAC) is a well-known complication of Barrett's esophagus (BE). Several factors may increase the risk for progression to EAC including presence of dysplasia. The significance of a family history of EAC in the progression to EAC in patients with BE has not been thoroughly evaluated. The purpose of this study is to evaluate the presence of EAC in a first degree family member in evaluating patients with BE. Methods: A retrospective cohort study was conducted of patients with BE at a tertiary care center undergoing radiofrequency ablation (RFA) over a 10 year period. The electronic medical record was reviewed to collect the following data: age, sex, age at diagnosis of BE and EAC, pathology, and length of BE segment. Family history was assessed in all BE patients, with and without EAC. Results: 301 patients with BE who underwent RFA were assessed. 19 patients who had a diagnosis of intramucosal adenocarcinoma on index endoscopy were excluded. 19 (6.7%) patients had a first degree relative (FDR) with a history of EAC. 4 of 19 (21.1%) patients with FDR with EAC progressed to EAC. 22 of 263 (8.7%) patients without FDR with EAC progressed to EAC. In a logistic regression model adjusted for sex and the number of RFA treatments, we found that family history of EAC was a significant independent predictor of progression to adenocarcinoma (OR=5.55, 95%CI: 1.47-20.0). Conclusion: Our study indicates that BE patients with a first degree family member with EAC are at 5.5-fold higher risk for disease progression to EAC. Our study suggests that family history of EAC is an independent risk factor for the development of EAC in BE patients and should be carefully considered in patient surveillance and RFA treatment, beyond current recommended guidelines.