推荐对轻度-中度异型增生和阴性内窥镜结果进行内窥镜监测，时间间隔分别为3年和5年，但证据有限。本研究旨在评估经过单次内窥镜筛查后的食管癌（EC）长期发病率和死亡率。我们纳入了2007-2012年在中国农村的六个中心进行内窥镜筛查的40-69岁食管癌高危人群，其基线诊断结果为阴性内窥镜结果、轻度异型增生或中度异型增生。对参与者进行EC发病率和死亡率的随访。通过Kaplan-Meier分析估计EC的累积发病率和死亡率。使用Cox回归模型计算基线内窥镜诊断与EC发病率和死亡率之间关联的调整危险比（HR）和95%置信区间（CI）。使用标化发病率比（SIR）和标化死亡率比（SMR）比较单次内窥镜筛查后的EC发病率和死亡率与中国农村人群的情况。共纳入42,827名参与者（其中40,977名阴性内窥镜结果，1562名轻度异型增生和288名中度异型增生）；在中位数10.62年的随访期间，确认268例EC病例和128例EC死亡。10年时，阴性内窥镜结果组中的累积EC发病率为0.45%（0.38-0.52），轻度异型增生组为2.39%（1.62-3.16），中度异型增生组为8.90%（5.57-12.24）；10年时的累积EC死亡率分别为0.23%（0.18-0.27），0.96%（0.46-1.46）和2.50%（0.67-4.33）。与阴性内窥镜结果组相比，轻度异型增生组的EC发病率和死亡率的HR值分别为3.52（2.49-4.97）和2.43（1.41-4.19），中度异型增生组分别为13.18（8.78-19.76）和6.46（3.13-13.29）。轻度异型增生组的SIR为1.95（1.69-2.24），中度异型增生组为6.75（6.25-7.28）；SMR分别为0.43（0.31-0.58），1.07（0.88-1.29）和2.67（2.36-3.01）。单次内窥镜筛查后阴性内窥镜结果的个体EC风险比普通人群低，持续时间可达10.62年，而轻度-中度异型增生者的风险升高。我们的结果支持每3年对轻度-中度异型增生进行内窥镜监测，并建议阴性内窥镜结果后将监测间隔延长至10年。中国国家重点研发计划、京津冀基础研究合作专项和深圳三明市医学项目资助。© 2023 The Author(s).

Endoscopy surveillance is recommended for mild-moderate dysplasia and negative endoscopy findings every 3 years and 5 years, respectively, but evidence is limited. This study aimed to assess long-term esophageal cancer (EC) incidence and mortality after a single endoscopy screening.We included individuals at high risk of EC aged 40-69 years who underwent endoscopy screening in 2007-2012 at six centres in rural China and had a baseline diagnosis of negative endoscopy findings, mild dysplasia, or moderate dysplasia. Participants were followed up for EC incidence and mortality. Cumulative incidence and mortality rates of EC were estimated by Kaplan-Meier analyses. Cox regression models were used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between baseline endoscopy diagnosis and the risk of EC incidence and mortality. EC incidence and mortality after a single endoscopy screening were compared with those of the population in rural China by the standardized incidence ratio (SIR) and standardized mortality ratio (SMR).A total of 42,827 participants (40,977 with negative endoscopy findings, 1562 with mild dysplasia, and 288 with moderate dysplasia) were included; 268 EC cases and 128 EC deaths were identified during a median follow-up of 10.62 years. The cumulative EC incidence at 10 years was 0.45% (0.38-0.52) in the group with negative endoscopy findings, 2.39% (1.62-3.16) in the mild dysplasia group, and 8.90% (5.57-12.24) in the moderate dysplasia group, and the cumulative EC mortality at 10 years was 0.23% (0.18-0.27), 0.96% (0.46-1.46), and 2.50% (0.67-4.33), respectively. Compared with individuals with negative endoscopy findings, the HRs for EC incidence and mortality in the mild dysplasia group were 3.52 (2.49-4.97) and 2.43 (1.41-4.19), and those in the moderate dysplasia group were 13.18 (8.78-19.76) and 6.46 (3.13-13.29), respectively. The SIR was 0.53 (0.40-0.70) for the group with negative endoscopy findings, 1.95 (1.69-2.24) for the mild dysplasia group, and 6.75 (6.25-7.28) for the moderate dysplasia group, with the SMRs of 0.43 (0.31-0.58), 1.07 (0.88-1.29) and 2.67 (2.36-3.01), respectively.Individuals with negative endoscopy findings after a single endoscopy screening had a lower EC risk than the general population for up to 10.62 years, while those with mild-moderate dysplasia had an elevated risk. Our results support endoscopy surveillance for mild-moderate dysplasia every 3 years and suggest extending the interval to 10 years after a negative endoscopy finding.National Key R&D Programme of China, Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation, and Sanming Project of Medicine in Shenzhen.© 2023 The Author(s).