Low risk of adenocarcinoma and high-grade dysplasia in patients with non-dysplastic Barrett’s esophagus: Results from a cohort from a country with low esophageal adenocarcinoma incidence

Abstract

Background: The risk of esophageal adenocarcinoma (EAC) in non-dysplastic Barrett's esophagus (NDBE) is considered to be approximately 0.3% per year or even lower, according to population-based studies. Data from countries with low EAC incidence are scarce. Our principal aim was to determine the incidence of high-grade dysplasia (HGD) and EAC in NDBE. Our secondary aims were to identify the predictors of progression and to calculate the incidence of HGD/EAC, by using the calculation method for surveillance time in population-based studies. Materials and methods: A cohort of NDBE patients was prospectively followed up. Cases of HGD and EAC (study end points) diagnosed during the first year of follow-up were considered as prevalent. Only cases with an endoscopic surveillance time > 1 year were included in our analysis. Results: We enrolled 331 patients (251 men) in the surveillance program. Their median age was 59 years (interquartile range (IQR): 47-67 years). Their median NDBE length was 3 cm (IQR: 2-4 cm). Of these patients, 80 died during the follow-up (one from EAC) and two were lost to follow-up. After 2284 patient-years of endoscopic follow-up (median surveillance time, 5 years (IQR: 2-10 years)), we found that five cases of HGD and two cases of EAC were diagnosed. The incidence of HGD/EAC was 3.1 cases per 1000 patient-years (95% CI: 1.3-6.0) and that of EAC was 0.9 (95% CI: 0.2-2.9). The incidence of HGD/EAC in short segments ( 3 cm) was 0.7 cases per 1000 patient-years (95% CI: 0.3-3.4). The sole variable that we found associated with progression was NDBE length. If the total surveillance time was considered (3537 patient-years), the incidence of HGD and EAC was only slight lower. Conclusions: The incidence of HGD and EAC was very low in NDBE. Therefore, current surveillance guidelines must be reassessed, at least for short-segment BE.

Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

“…Some recent guidelines have excluded patients with a segment length < 1 cm for the diagnosis of BE. Given that this is a recent update, we were able to identify only two studies [18,28] that specifically defined SSBE as a length < 3 cm but also excluded patients with a segment length of < 1 cm (i. e. short-segment length being ≥ 1 cm to < 3 cm).…”

“…A meta-analysis by Desai et al in 2012 reported an annual EAC incidence rate of 0.33 % in patients with NDBE, but did not provide a comparison between SSBE and LSBE patients [10]. More recently, observational studies have been published comparing the risk of progression between these two patient groups, but precise estimates have varied [17,18]. Our aim was to perform a systematic review and meta-analysis of published studies to provide a more accurate estimate of the risk of neoplastic progression in NDBE patients based on the length of the BE segment.…”

Screening for Barrett's Esophagus: Balancing Clinical Value and Cost-effectiveness

“…Supporting this concept, the annual risk of progression to EAC is higher in HGD (6.0-7.0%) 18,19 compared to community LGD diagnoses (0.4-0.6%) 20,21 or non-dysplastic BE (0.1-0.3%, which has decreased in recent decades from previous higher estimated ranges). [22][23][24][25][26][27] Data suggest superior survival outcomes when EAC is diagnosed in pre-existing BE. In a study based on Surveillance, Epidemiology, and End Results and linked Medicare data, patients diagnosed with EAC in the setting of pre-existing BE had overall lower stage EAC and superior overall survival compared to those diagnosed with EAC without pre-existing BE (hazard ratio, 0.56; 95% CI, 0.50-0.61 that persisted in an adjusted model with hazard ratio, 0.72; 95% CI, 0.65-0.80).…”

Histopathology of Barrett’s Esophagus and Early-Stage Esophageal Adenocarcinoma: An Updated Review

“…The term "long segment BE" is defined as the length of columnar mucosa >3 cm, and "short segment BE" is used when the length is between 1 and 3 cm. Increased length of columnar mucosa is associated with increased incidence of intestinal metaplasia and about 46% increase in the risk of cancer progression for every 1 cm increase in the BE length [13]. For BE diagnosis, the American College of Gastroenterology (ACG) recommends four random biopsies every 2 cm, or 8 random biopsies to maximize the yield of intestinal metaplasia on histology.…”