Patients With Nondysplastic Barrett's Esophagus Have Low Risks for Developing Dysplasia or Esophageal Adenocarcinoma

Sachin Wani, Gary Falk, Matthew Hall, Srinivas Gaddam, Amy Wang, Neil Gupta, Mandeep Singh, Vikas Singh, Keng Yu Chuang, Vikram Boolchand, Hemanth Gavini, John Kuczynski, Priti Sud, Savio Reddymasu, Ajay Bansal, Amit Rastogi, Sharad C. Mathur, Patrick Young, Brooks Cash, David A. LiebermanRichard E. Sampliner, Prateek Sharma

Research output: Contribution to journalArticle

150 Scopus citations

Abstract

Background & Aims: The risks of dysplasia and esophageal adenocarcinoma (EAC) are not clear for patients with nondysplastic Barrett's esophagus (NDBE); the rate of progression has been overestimated in previous studies. We studied the incidences of dysplasia and EAC and investigated factors associated with progression of BE. Methods: The BE study is a multicenter outcomes project of a large cohort of patients with BE. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Patients followed up for at least 1 year after the index endoscopy examination were included, whereas those diagnosed with dysplasia and EAC within 1 year of diagnosis with BE (prevalent cases) were excluded. Of 3334 patients with BE, 1204 met the inclusion criteria (93.7% Caucasian; 88% male; mean age, 59.3 y) and were followed up for a mean of 5.52 years (6644.5 patient-years). Results: Eighteen patients developed EAC (incidence, 0.27%/y; 95% confidence interval [CI], 0.17-0.43) and 32 developed HGD (incidence, 0.48%/y; 95% CI, 0.34-0.68). The incidence of HGD and EAC was 0.63%/y (95% CI, 0.47-0.86). There were 217 cases of low-grade dysplasia (incidence, 3.6%/y; 95% CI, 3.2-4.1). Five and 10 years after diagnosis, 98.6% (n = 540) and 97.1% (n = 155) of patients with NDBE were cancer free, respectively. The length of the BE was associated significantly with progression (EAC <6 cm, 0.09%/y vs EAC ≥6 cm, 0.65%/y; P = 0.001). Conclusions: There is a lower incidence of dysplasia and EAC among patients with NDBE than previously reported. Because most patients are cancer free after a long-term follow-up period, surveillance intervals might be lengthened, especially for patients with shorter segments of BE.

Original languageEnglish (US)
Pages (from-to)220-227.e1
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number3
DOIs
StatePublished - Mar 2011

Keywords

  • Barrett's Esophagus
  • Dysplasia
  • Esophageal Adenocarcinoma
  • Esophageal Cancer
  • Prevention
  • Screening
  • Surveillance

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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    Wani, S., Falk, G., Hall, M., Gaddam, S., Wang, A., Gupta, N., Singh, M., Singh, V., Chuang, K. Y., Boolchand, V., Gavini, H., Kuczynski, J., Sud, P., Reddymasu, S., Bansal, A., Rastogi, A., Mathur, S. C., Young, P., Cash, B., ... Sharma, P. (2011). Patients With Nondysplastic Barrett's Esophagus Have Low Risks for Developing Dysplasia or Esophageal Adenocarcinoma. Clinical Gastroenterology and Hepatology, 9(3), 220-227.e1. https://doi.org/10.1016/j.cgh.2010.11.008