The incidence of dysplasia at the first endoscopy in patients with barrett's esophagus

Introduction: In patients with Barrett's esophagus, the incidence of adenocarcinoma at presentation and with follow-up is estimated to be 10% and 1% per year, respectively. The incidence of dysplasia at the index endoscopy is not well documented. Aim: To determine the incidence of dysplasia in patients with Barrett's esophagus at the time of initial surveillance endoscopy. Methods: We reviewed our endoscopy and histology data from 1992 to 1997. In consecutive patients undergoing EGD for any mdication, 4 quadrant biopsies were taken just below the squamocolumnar junction and every two centimeters within any columnar lined esophagus (CLE). The extent of CLE above the gastric folds and the worst pathologic diagnosis were recorded. Patients were excluded if they were undergoing surveillance for known Barrett's esophagus, were referred for evaluation of known dysplasia or had a mass lesion suspicious for malignancy. We defined long segment Barrett's esophagus (LSBE) as finding IM in at least 3 cm. of distal esophagus. Short segment Barrett's esophagus (SSBE) was denned as finding IM in less than 3 cm. of distal esophagus. Results: 116 patients had endoscopic and histologic evidence of Barrett's esophagus. Eight (6.9%) had evidence of low grade dysplasia, none had high grade dysplasia. 1/41 (2.4%) patients with SSBE had dysplasia. 7/75 (9.3%) patients with LSBE had dysplasia. Conclusions: Dysplasia occurs frequently in patients at the index endoscopy. Surveillance biopsies should be taken at the first endoscopy.