Endoscopy Every 2 Years or Only as Needed in Monitoring Patients With Barrett Esophagus

NCT ID: NCT00987857

Last Updated: 2017-08-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

3400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-03-31

Study Completion Date

2022-05-31

Brief Summary

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RATIONALE: Screening tests may help doctors find cancer cells early and plan better treatment. It is not yet known whether endoscopy every 2 years is more effective than endoscopy only as needed in finding esophageal cancer in patients with Barrett esophagus.

PURPOSE: This randomized phase III trial is studying endoscopy every 2 years to see how well it works compared with endoscopy only as needed in monitoring patients with Barrett esophagus.

Detailed Description

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OBJECTIVES:

Primary

* To establish whether endoscopic surveillance every 2 years or endoscopy at need only is superior in terms of overall survival and, if neither is superior, whether endoscopy at need only is non-inferior to surveillance every 2 years in patients with Barrett esophagus.

Secondary

* To estimate the cost-effectiveness of endoscopic surveillance every 2 years as compared to endoscopy at need only.
* To establish whether there is a significant difference between endoscopic surveillance every 2 years or endoscopy at need only in terms of the incidence of esophageal cancer, gastric or esophageal cancer, or all cancers.
* To establish whether there is a significant difference between endoscopic surveillance every 2 years or endoscopy at need only in terms of the time to diagnosis of esophageal adenocarcinoma.
* To establish whether there is a significant difference between endoscopic surveillance every 2 years or endoscopy at need only in terms of the stage of esophageal adenocarcinoma at diagnosis using TNM staging.
* To establish whether there is a significant difference between endoscopic surveillance every 2 years or endoscopy at need only in terms of morbidity and mortality related to endoscopy, esophageal surgery, and other endoscopy-related interventions (e.g., ablation).
* To establish whether there is a significant difference between endoscopic surveillance every 2 years or endoscopy at need only in terms of the frequency of endoscopy.

OUTLINE: This is a multicenter study. Patients are stratified according to age at diagnosis (\< 65 years vs ≥ 65 years), length of Barrett metaplasia segment including tongues (\< 2 cm vs ≥ 2 cm and ≤ 3 cm vs \> 3 cm and ≤ 8 cm vs \> 8 cm), and newly diagnosed disease (defined as the date of endoscopy confirming Barrett metaplasia was within the past 4 months) (yes vs no). Patients are randomized to 1 of 2 intervention arms.

* Arm I: Patients undergo surveillance endoscopy with quadrantic biopsies taken every 2 cm. Patients undergo endoscopy every 2 years for a total of 6 endoscopies over 10 years.
* Arm II: Patients undergo endoscopy as needed over 10 years. All patients may undergo urgent endoscopy if they develop dysphagia, unexplained weight loss of \> 7 lb, iron-deficiency anemia, recurrent vomiting, or worsening upper gastrointestinal symptoms.

All patients complete a questionnaire that includes a quality-of-life measure and questions about medication at baseline, every 2 years, and following key events (e.g., diagnosis of any cancer or high-grade dysplasia).

Conditions

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Esophageal Cancer Precancerous Condition

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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2 yearly endoscopies

Two years endoscopies

Group Type ACTIVE_COMPARATOR

2 yearly endoscopy

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

comparison of screening methods

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

diagnostic endoscopic procedure

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

endoscopic biopsy

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

endoscopic procedure

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

quality-of-life assessment

Intervention Type PROCEDURE

QOL aims to elicit any differences in QOL between 2 yearly endoscopy versus endoscopy at need

screening method

Intervention Type PROCEDURE

All Barretts patients to be screened

endoscopy at need

Endoscopy only when patient reports symptoms

Group Type EXPERIMENTAL

2 yearly endoscopy

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

comparison of screening methods

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

diagnostic endoscopic procedure

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

endoscopic biopsy

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

endoscopic procedure

Intervention Type PROCEDURE

2 yearly endoscopy versus endoscopy at need

quality-of-life assessment

Intervention Type PROCEDURE

QOL aims to elicit any differences in QOL between 2 yearly endoscopy versus endoscopy at need

screening method

Intervention Type PROCEDURE

All Barretts patients to be screened

Interventions

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2 yearly endoscopy

2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

comparison of screening methods

2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

diagnostic endoscopic procedure

2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

endoscopic biopsy

2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

endoscopic procedure

2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

quality-of-life assessment

QOL aims to elicit any differences in QOL between 2 yearly endoscopy versus endoscopy at need

Intervention Type PROCEDURE

screening method

All Barretts patients to be screened

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Histologically confirmed circumferential Barrett metaplasia meeting 1 of the following criteria:

* At least 1 cm from the gastro-esophageal junction
* At least a 2 cm non-circumferential tongue of Barrett metaplasia
* Undergone endoscopy within the last 2 years to confirm Barrett metaplasia and exclude high-grade dysplasia and carcinoma
* No known high-grade dysplasia or carcinoma

PATIENT CHARACTERISTICS:

* Resident of the United Kingdom
* Informed of the risk of Barrett esophagus developing into esophageal cancer, either at the visit when the invitation letter is issued or on a documented previous occasion
* Able to undergo endoscopy
* No medical conditions that would make endoscopy difficult or hazardous

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
Minimum Eligible Age

18 Years

Maximum Eligible Age

120 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Gloucestershire Hospitals NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Clive Stokes

Professor Hugh Barr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hugh Barr

Role: PRINCIPAL_INVESTIGATOR

Gloucestershire Hospitals NHS Foundation Trust

Locations

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Gloucestershire Royal Hospital

Gloucester, England, United Kingdom

Site Status

Countries

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United Kingdom

References

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Old O, Jankowski J, Attwood S, Stokes C, Kendall C, Rasdell C, Zimmermann A, Massa MS, Love S, Sanders S, Deidda M, Briggs A, Hapeshi J, Foy C, Moayyedi P, Barr H; BOSS Trial Team. Barrett's Oesophagus Surveillance Versus Endoscopy at Need Study (BOSS): A Randomized Controlled Trial. Gastroenterology. 2025 Apr 1:S0016-5085(25)00587-6. doi: 10.1053/j.gastro.2025.03.021. Online ahead of print.

Reference Type DERIVED
PMID: 40180292 (View on PubMed)

Other Identifiers

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CDR0000649890

Identifier Type: REGISTRY

Identifier Source: secondary_id

ISRCTN54190466

Identifier Type: -

Identifier Source: secondary_id

NHS-GRH-HTA-05/12/01

Identifier Type: -

Identifier Source: org_study_id

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