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

Accepted version
Peer-reviewed

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Authors

Phillips, Richard 
Januszewicz, Wladyslaw 
Pilonis, Nastazja D 
O'Donovan, Maria 
Sawas, Tarek 

Abstract

BACKGROUND AND AIMS: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Description

Keywords

Adenocarcinoma, Barrett Esophagus, Cohort Studies, Disease Progression, Esophageal Neoplasms, Humans, Precancerous Conditions, Retrospective Studies

Journal Title

Gastrointest Endosc

Conference Name

Journal ISSN

0016-5107
1097-6779

Volume Title

94

Publisher

Elsevier BV
Sponsorship
MRC (unknown)
Medical Research Council (MC_UU_12022/2)
MRC (MR/W014122/1)
MRC core grant to RCF with infrastructure support from Cambridge BRC and NIHR