Endoscopic features of low-grade dysplastic Barrett’s

Abstract

Introduction Barrett’s oesophagus (BO) with low grade dysplasia (LGD) is considered usually endoscopically invisible and the endoscopic features are not well described. This study aims to (1) evaluate the frequency of visible BO-LGD, (2) compare the rates of BO-LGD detection in the community versus a Barrett’s referral unit (BRU) and (3) evaluate the endoscopic features of BO-LGD. Methods This is a retrospective analysis of a prospectively observed cohort of 497 patients referred to a BRU with dysplastic BO between 2008 and 2022. BO-LGD was defined as confirmation of LGD by expert GI pathologist(s). Endoscopy reports, images and histology reports were reviewed to evaluate the frequency of endoscopically identifiable BO-LGD and their endoscopic features. Results 135 patients (27.2%) had confirmed BO-LGD, of which 15 (11.1%) had visible LGD identified in the community. After BRU assessment, visible LGD was detected in 68 patients (50.4%). Three phenotypes were observed: (A) Non-visible LGD, (B) Elevated (Paris 0-IIa) lesions and (C) Flat (Paris 0-IIb) lesions with abnormal mucosal and/or vascular patterns with clear demarcation from regular flat BO. Majority (64.7%) of visible LGD were flat lesions with abnormal mucosal and vascular patterns. Endoscopic detection of BO-LGD increased over time (38.7% (2009-2012) vs. 54.3% (2018-2022)). Conclusion In this cohort, 50.4% of true BO-LGD was endoscopically visible, with increased recognition endoscopically over time and a higher rate of visible LGD detected at a BRU when compared with the community. BRU assessment of BO-LGD remains crucial, however improving endoscopy surveillance quality in the community is equally important.

Low-grade dysplasia on Barrett’s esophagus: visible or not ?

“…investigated the frequency of visible LGD among patients with dysplastic BE referred to an expert center in Melbourne, and sought to describe the endoscopic features of BE with LGD [3].…”