Risk of progression in Barrett’s esophagus indefinite for dysplasia: a systematic review and meta-analysis

Abstract

Background and Aims: Risk of progression in Barrett's esophagus (BE) with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) has been established. However, the natural history of BE with indefinite dysplasia (BE-IND) remains unclear. We performed a systematic review and meta-analysis to estimate the pooled risk of progression to HGD and/or esophageal adenocarcinoma (EAC) in BE-IND. Methods:We performed a systematic search of multiple databases to June 2018 to identify studies reporting the incidence of HGD, EAC, or HGD/EAC as an outcome in patients with BE-IND undergoing endoscopic surveillance. The pooled incidence rate of HGD and/or EAC and EAC alone was estimated. Results:We identified 8 studies reporting the incidence of HGD and/or EAC and 5 studies reporting the incidence of EAC in BE-IND. The pooled incidence of HGD and/or EAC (89 cases in 1441 patients over 5306.2 person-years) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0). The pooled incidence of EAC (40 cases in 1266 patients over 4520.2 person-years) was 0.6 per 100 person-years (95% CI, 0.1-1.1). Substantial heterogeneity was noted in the analyses. On subgroup analysis, the incidence of EAC was higher in studies from Europe compared with North America (0.9% vs 0.1%, P Z .01). The pooled incidence of LGD was 11.4 per 100 person-years (95% CI, 0.06-0.2). Conclusion:The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance. (Gastrointest Endosc 2020;91:3-10.)

State of the Art: Management of Barrett’s Esophagus Related Dysplasia and Neoplasia—Which Patient and What Therapy?

“…Patients are selected for EET by balancing the risks versus benefits and assessing the efficacy of treatment methods. Since patients with non-dysplastic Barrett’s esophagus (NDBE) or indefinite dysplasia have low risk of progression to HGD/EAC with annual rates of progression estimated from 0.33% to 0.5%, 2,3 EET is not currently recommended in these individuals except under special circumstances (such as confirmed family history of BE or EAC). EET is recommended in the following situations:…”

The role of esophagectomy in the management of Barrett's esophagus with high‐grade dysplasia

“…57 Current guidelines for the management of BE make recommendations depending on the degree of dysplasia. 4,58 British guidelines recommend individualizing surveillance for NDBE based on length and histopathological findings. For NDBE without IM and length less than 3 cm on two separate endoscopies, patients can be discharged from surveillance given the low rate of progression (0.05%/annum).…”

TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

“…Pathologic analysis also can be confounded by cases that are difficult to diagnose, for example, if there is a background of inflammation, which can result in a diagnosis of "indefinite" for dysplasia (IND). These IND cases also present a management challenge because there is substantial heterogeneity between studies reporting on the progression risk associated with IND [12].…”