Efficacy of Endoscopy Screening on Esophageal Cancer in China (ESECC)

To evaluate the efficacy of endoscopic screening on esophageal cancer (EC) and determine the most cost-effective strategy of endoscopic screening in high risk population in China, 668 villages of Hua county, a high risk area of esophageal cancer, were randomized into screening arm and control arm in a ratio of 1:1 and the total sample size is over 32,000 (\~16,000 per group). Participants in the screening arm will accept standard chromoendoscopy examination to detect early esophageal cancer and no screening were designed in the control arm. The incidence of advanced EC, EC-specific mortality and all-cause mortality will be compared within the two groups to test the hypothesis that endoscopic screening would alter the natural history of lesions in esophagus and the incidence of advanced stage EC, EC-specific mortality and all-cause mortality in the screening arm will be lower than the control group. Cost-effectiveness analysis will also be conducted to find the most cost-effective strategy of endoscopic screening in rural China.

Sex

All

Minimum age

45 Years

Maximum age

69 Years

Participants were eligible for the study if they meet the following criteria: 1) permanent residency in a target village; 2) age 45-69 (\>5 years of life expectancy), and no history of endoscopic examination within 5 years prior to the initial interview; 3) no history of cancer or mental disorder; 4) negative for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV); 5) voluntary participation and agreement to complete all phases of the examination.

• RESULTHe Z, Liu Z, Liu M, Guo C, Xu R, Li F, Liu A, Yang H, Shen L, Wu Q, Duan L, Li X, Zhang C, Pan Y, Cai H, Ke Y. Efficacy of endoscopic screening for esophageal cancer in China (ESECC): design and preliminary results of a population-based randomised controlled trial. Gut. 2019 Feb;68(2):198-206. doi: 10.1136/gutjnl-2017-315520. Epub 2018 Jan 6. PMID 29306867
• DERIVEDLiu M, Yang W, Guo C, Liu Z, Li F, Liu A, Yang H, Shen L, Wu Q, Duan L, Wang H, Tian H, Shi C, Pan Y, Liu Y, Liu F, Cai H, He Z, Ke Y. Effect of endoscopic screening for non-cardia gastric cancer: a 12-year report of a population-based randomized trial. BMC Med. 2026 Jul 6. doi: 10.1186/s12916-026-05043-z. Online ahead of print. PMID 42410417
• DERIVEDYang W, Liu M, Qi Z, Huang Y, Liu Z, Guo C, Liu A, Yang H, Li F, Liu Y, Liu F, Pan Y, Cai H, He Z, Ke Y. Is random biopsy necessary for normal esophageal mucosa during chromoendoscopy? Evidence from a population-based cohort study. BMC Med. 2026 Mar 2;24(1):202. doi: 10.1186/s12916-026-04759-2. PMID 41765898
• DERIVEDHe Z, Ke Y. Evolving diagnostic and surveillance strategies in esophageal cancer screening: Evidence from population-based studies in China. Chin J Cancer Res. 2025 Dec 30;37(6):929-936. doi: 10.21147/j.issn.1000-9604.2025.06.05. PMID 41523838
• DERIVEDWu M, Tian H, Guo C, Liu Z, Pan Y, Liu F, Liu Y, Yang W, Chen H, Hu Z, Liu M, He Z, Ke Y. Early-life undernutrition increases the risk of death from chronic diseases in adulthood: a population-based cohort study. Glob Health Res Policy. 2025 Jul 10;10(1):28. doi: 10.1186/s41256-025-00422-0. PMID 40635115
• DERIVEDChen L, Wang H, Qi Z, Liang L, Guo C, He Y, Liu M, Liu Z, Pan Y, Liu F, Liu Y, Hu Z, Chen H, He Z, Ke Y. Dynamics of Long-Term Quality of Life After Treatment for Esophageal Cancer: A Community-Based Patient Study. JCO Glob Oncol. 2024 Jul;10:e2400044. doi: 10.1200/GO.24.00044. PMID 38995686