Systemic sclerosis (scleroderma) and esophageal adenocarcinoma: Is increased patient screening necessary?

An increased risk of esophageal carcinoma has been reported in systemic sclerosis (scleroderma). Periodic endoscopic or radiologic surveillance, or both, of systemic sclerosis patients with gastroesophageal reflux symptoms has been recommended for early detection of Barrett's mucosa and esophageal adenocarcinoma. A review of 680 closely followed systemic sclerosis patients for esophageal carcinoma of all types, and of a 22-yr experience with esophageal and esophagogastric junction adenocarcinoma and undifferentiated carcinoma, did not reveal a significant increase in the frequency of esophageal carcinoma in systemic sclerosis. Regular surveillance for Barrett's esophagus and esophageal adenocarcinoma would not appear to be cost-effective because of the rarity of carcinoma, increased patient discomfort and expense, and the questionable benefit for long-term survival.