Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma

Results from a large multicenter cohort

Srinivas Gaddam, Mandeep Singh, Gokulakrishnan Balasubramanian, Prashanthi Thota, Neil Gupta, Sachin Wani, April D. Higbee, Sharad C. Mathur, John D. Horwhat, Amit Rastogi, Patrick E. Young, Brooks D. Cash, Ajay Bansal, John J. Vargo, Gary W. Falk, David Lieberman, Richard E. Sampliner, Prateek Sharma

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Background & Aims Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE). Methods We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer. Results Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3% white; 87.5% men; median age, 60 ±17 years). The median follow-up period was 5 ± 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively (P for trend =.03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC. Conclusions Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.

Original languageEnglish (US)
JournalGastroenterology
Volume145
Issue number3
DOIs
StatePublished - Sep 2013

Fingerprint

Barrett Esophagus
Adenocarcinoma
Endoscopy
Logistic Models
Digestive System Endoscopy
Multicenter Studies

Keywords

  • Barrett's Esophagus
  • Dysplasia
  • Esophageal Adenocarcinoma
  • Risk

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma : Results from a large multicenter cohort. / Gaddam, Srinivas; Singh, Mandeep; Balasubramanian, Gokulakrishnan; Thota, Prashanthi; Gupta, Neil; Wani, Sachin; Higbee, April D.; Mathur, Sharad C.; Horwhat, John D.; Rastogi, Amit; Young, Patrick E.; Cash, Brooks D.; Bansal, Ajay; Vargo, John J.; Falk, Gary W.; Lieberman, David; Sampliner, Richard E.; Sharma, Prateek.

In: Gastroenterology, Vol. 145, No. 3, 09.2013.

Research output: Contribution to journalArticle

Gaddam, S, Singh, M, Balasubramanian, G, Thota, P, Gupta, N, Wani, S, Higbee, AD, Mathur, SC, Horwhat, JD, Rastogi, A, Young, PE, Cash, BD, Bansal, A, Vargo, JJ, Falk, GW, Lieberman, D, Sampliner, RE & Sharma, P 2013, 'Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma: Results from a large multicenter cohort', Gastroenterology, vol. 145, no. 3. https://doi.org/10.1053/j.gastro.2013.05.040
Gaddam, Srinivas ; Singh, Mandeep ; Balasubramanian, Gokulakrishnan ; Thota, Prashanthi ; Gupta, Neil ; Wani, Sachin ; Higbee, April D. ; Mathur, Sharad C. ; Horwhat, John D. ; Rastogi, Amit ; Young, Patrick E. ; Cash, Brooks D. ; Bansal, Ajay ; Vargo, John J. ; Falk, Gary W. ; Lieberman, David ; Sampliner, Richard E. ; Sharma, Prateek. / Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma : Results from a large multicenter cohort. In: Gastroenterology. 2013 ; Vol. 145, No. 3.
@article{e3c34b7036f04c7baad5e2e692449443,
title = "Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma: Results from a large multicenter cohort",
abstract = "Background & Aims Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE). Methods We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer. Results Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3{\%} white; 87.5{\%} men; median age, 60 ±17 years). The median follow-up period was 5 ± 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32{\%}, 0.27{\%}, 0.16{\%}, 0.2{\%}, and 0.11{\%}, respectively (P for trend =.03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC. Conclusions Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.",
keywords = "Barrett's Esophagus, Dysplasia, Esophageal Adenocarcinoma, Risk",
author = "Srinivas Gaddam and Mandeep Singh and Gokulakrishnan Balasubramanian and Prashanthi Thota and Neil Gupta and Sachin Wani and Higbee, {April D.} and Mathur, {Sharad C.} and Horwhat, {John D.} and Amit Rastogi and Young, {Patrick E.} and Cash, {Brooks D.} and Ajay Bansal and Vargo, {John J.} and Falk, {Gary W.} and David Lieberman and Sampliner, {Richard E.} and Prateek Sharma",
year = "2013",
month = "9",
doi = "10.1053/j.gastro.2013.05.040",
language = "English (US)",
volume = "145",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for Esophageal Adenocarcinoma

T2 - Results from a large multicenter cohort

AU - Gaddam, Srinivas

AU - Singh, Mandeep

AU - Balasubramanian, Gokulakrishnan

AU - Thota, Prashanthi

AU - Gupta, Neil

AU - Wani, Sachin

AU - Higbee, April D.

AU - Mathur, Sharad C.

AU - Horwhat, John D.

AU - Rastogi, Amit

AU - Young, Patrick E.

AU - Cash, Brooks D.

AU - Bansal, Ajay

AU - Vargo, John J.

AU - Falk, Gary W.

AU - Lieberman, David

AU - Sampliner, Richard E.

AU - Sharma, Prateek

PY - 2013/9

Y1 - 2013/9

N2 - Background & Aims Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE). Methods We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer. Results Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3% white; 87.5% men; median age, 60 ±17 years). The median follow-up period was 5 ± 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively (P for trend =.03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC. Conclusions Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.

AB - Background & Aims Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE). Methods We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer. Results Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3% white; 87.5% men; median age, 60 ±17 years). The median follow-up period was 5 ± 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively (P for trend =.03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC. Conclusions Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.

KW - Barrett's Esophagus

KW - Dysplasia

KW - Esophageal Adenocarcinoma

KW - Risk

UR - http://www.scopus.com/inward/record.url?scp=84883170964&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883170964&partnerID=8YFLogxK

U2 - 10.1053/j.gastro.2013.05.040

DO - 10.1053/j.gastro.2013.05.040

M3 - Article

VL - 145

JO - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

IS - 3

ER -