The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia: a multicenter cohort study

Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in...

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Bibliographic Details
Published in:Gastrointestinal endoscopy Vol. 94; no. 2; pp. 263 - 270.e2
Main Authors: Phillips, Richard, Januszewicz, Wladyslaw, Pilonis, Nastazja D., O'Donovan, Maria, Sawas, Tarek, Katzka, David A., Fitzgerald, Rebecca C., di Pietro, Massimiliano
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.08.2021
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Subjects:
Adenocarcinoma - epidemiology
Barrett Esophagus - epidemiology
Cohort Studies
Disease Progression
Esophageal Neoplasms - epidemiology
Humans
Original
Precancerous Conditions - epidemiology
Retrospective Studies
BE
OR
HGD
SSBE
CI
EAC
LGD
PPI
LSBE
IQR
FU
BE-IND
IMC
ISSN:0016-5107, 1097-6779, 1097-6779
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Summary:Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND. Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression. Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016). Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted.
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Drs Phillips and Januszewicz contributed equally to this article as first authors.
ISSN:0016-5107
1097-6779
1097-6779
DOI:10.1016/j.gie.2021.01.042