Old, Oliver; Jankowski, Janusz; Attwood, Stephen; Stokes, Clive; Kendall, Catherine; Rasdell, Cathryn; Zimmermann, Alex; ... BOSS Trial team, .; + view all Old, Oliver; Jankowski, Janusz; Attwood, Stephen; Stokes, Clive; Kendall, Catherine; Rasdell, Cathryn; Zimmermann, Alex; Massa, M Sofia; Love, Sharon; Sanders, Scott; Deidda, Manuela; Briggs, Andrew; Hapeshi, Julie; Foy, Chris; Moayyedi, Paul; Barr, Hugh; BOSS Trial team, .; - view fewer (2025) Barrett’s Oesophagus Surveillance versus endoscopy at need Study (BOSS): a randomized controlled trial. Gastroenterology 10.1053/j.gastro.2025.03.021. (In press).

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Abstract

Background and aims: Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma (EA). Surveillance endoscopy aims to detect early malignant progression: though widely practised it has not previously been tested in a randomized trial.// Methods: BOSS was a randomized controlled trial at 109 centres in the UK. Patients with BE were randomized to two-yearly surveillance endoscopy or ‘at need’ endoscopy, offered only for symptoms. Follow up was a minimum of 10 years. The primary outcome was overall survival in the intention-to-treat population. Secondary outcomes included cancer-specific survival; time to diagnosis of EA; stage of EA at diagnosis; frequency of endoscopy and serious adverse events related to interventions.// Results: 3453 patients were recruited. 1733 patients were randomized to surveillance and 1719 to ‘at need’ endoscopy. Median follow up time was 12·8 years for the primary outcome. There was no evidence of a difference in overall survival between surveillance (333 deaths in 1733 patients) versus ‘at need’ arms (356 deaths in 1719 patients), hazard ratio 0·95 (95% CI 0·82-1·10), stratified log-rank p=0·503). There was no evidence of a difference for surveillance versus ‘at need’ endoscopy in cancer-specific survival (108 vs. 106 deaths from any cancer, HR 1·01 (95% CI 0·77-1·33), p=0·926), time to diagnosis of EA (40 vs. 31 patients had a diagnosis of EA, HR 1·32 (95% CI 0·82-2·11), p=0·254), or cancer stage at diagnosis. 8 (0·46%) surveillance patients and 7 (0·41%) ‘at need’ patients reported serious adverse events.// Conclusion: Surveillance did not improve overall survival or cancer-specific survival. ‘At need’ endoscopy may be a safe alternative for low-risk patients.

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