Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma

Nour Hamade, Sreekar Vennelaganti, Sravanthi Parasa, Prashanth Vennalaganti, Srinivas Gaddam, Manon C.W. Spaander, Sophie H. van Olphen, Prashanthi N. Thota, Kevin F. Kennedy, Marco J. Bruno, John J. Vargo, Sharad Mathur, Brooks D. Cash, Richard Sampliner, Neil Gupta, Gary W. Falk, Ajay Bansal, Patrick E. Young, David Lieberman, Prateek Sharma

Research output: Contribution to journalArticle

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Abstract

Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StatePublished - Jan 1 2019

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Barrett Esophagus
Adenocarcinoma
Guidelines
Endoscopy
Proportional Hazards Models
Tertiary Care Centers
Demography

Keywords

  • Esophageal Cancer
  • Long-Term Follow-Up
  • Outcome
  • Risk Factor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma. / Hamade, Nour; Vennelaganti, Sreekar; Parasa, Sravanthi; Vennalaganti, Prashanth; Gaddam, Srinivas; Spaander, Manon C.W.; van Olphen, Sophie H.; Thota, Prashanthi N.; Kennedy, Kevin F.; Bruno, Marco J.; Vargo, John J.; Mathur, Sharad; Cash, Brooks D.; Sampliner, Richard; Gupta, Neil; Falk, Gary W.; Bansal, Ajay; Young, Patrick E.; Lieberman, David; Sharma, Prateek.

In: Clinical Gastroenterology and Hepatology, 01.01.2019.

Research output: Contribution to journalArticle

Hamade, N, Vennelaganti, S, Parasa, S, Vennalaganti, P, Gaddam, S, Spaander, MCW, van Olphen, SH, Thota, PN, Kennedy, KF, Bruno, MJ, Vargo, JJ, Mathur, S, Cash, BD, Sampliner, R, Gupta, N, Falk, GW, Bansal, A, Young, PE, Lieberman, D & Sharma, P 2019, 'Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2018.07.008
Hamade, Nour ; Vennelaganti, Sreekar ; Parasa, Sravanthi ; Vennalaganti, Prashanth ; Gaddam, Srinivas ; Spaander, Manon C.W. ; van Olphen, Sophie H. ; Thota, Prashanthi N. ; Kennedy, Kevin F. ; Bruno, Marco J. ; Vargo, John J. ; Mathur, Sharad ; Cash, Brooks D. ; Sampliner, Richard ; Gupta, Neil ; Falk, Gary W. ; Bansal, Ajay ; Young, Patrick E. ; Lieberman, David ; Sharma, Prateek. / Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma. In: Clinical Gastroenterology and Hepatology. 2019.
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abstract = "Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5{\%} male; 88.1{\%} Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07{\%}) than of patients with LSBE (0.25{\%}) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29{\%}) compared to compared to LSBE (0.91{\%}) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95{\%} CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07{\%}/year) than of LSBE (0.25{\%}/year). We propose lengthening current surveillance intervals for patients with SSBE.",
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author = "Nour Hamade and Sreekar Vennelaganti and Sravanthi Parasa and Prashanth Vennalaganti and Srinivas Gaddam and Spaander, {Manon C.W.} and {van Olphen}, {Sophie H.} and Thota, {Prashanthi N.} and Kennedy, {Kevin F.} and Bruno, {Marco J.} and Vargo, {John J.} and Sharad Mathur and Cash, {Brooks D.} and Richard Sampliner and Neil Gupta and Falk, {Gary W.} and Ajay Bansal and Young, {Patrick E.} and David Lieberman and Prateek Sharma",
year = "2019",
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TY - JOUR

T1 - Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma

AU - Hamade, Nour

AU - Vennelaganti, Sreekar

AU - Parasa, Sravanthi

AU - Vennalaganti, Prashanth

AU - Gaddam, Srinivas

AU - Spaander, Manon C.W.

AU - van Olphen, Sophie H.

AU - Thota, Prashanthi N.

AU - Kennedy, Kevin F.

AU - Bruno, Marco J.

AU - Vargo, John J.

AU - Mathur, Sharad

AU - Cash, Brooks D.

AU - Sampliner, Richard

AU - Gupta, Neil

AU - Falk, Gary W.

AU - Bansal, Ajay

AU - Young, Patrick E.

AU - Lieberman, David

AU - Sharma, Prateek

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.

AB - Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.

KW - Esophageal Cancer

KW - Long-Term Follow-Up

KW - Outcome

KW - Risk Factor

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U2 - 10.1016/j.cgh.2018.07.008

DO - 10.1016/j.cgh.2018.07.008

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C2 - 30012433

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JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

SN - 1542-3565

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