Yield of Repeat Endoscopy in Barrett’s Esophagus with No Dysplasia and Low-Grade Dysplasia: A Population-Based Study

Summary Barrett’s esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett’s epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19–4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context.

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LOW-GRADE DYSPLASIA IN BARRETT’S ESOPHAGUS IS DOWNGRADED IN HALF OF THE CASES AFTER SYSTEMATIC EXPERT PATHOLOGY REVIEW BEFORE PATIENT REFERRAL FOR ENDOSCOPIC TREATMENT

10.1055/s-0040-1704296 ◽

2020 ◽

Author(s):

P Leclercq ◽

G De Hertogh ◽

R Bisschops

Keyword(s):

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Low Grade ◽

Patient Referral ◽

Low Grade Dysplasia ◽

Pathology Review

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Faculty Opinions recommendation of Patients With Barrett's Esophagus and Confirmed Persistent Low-Grade Dysplasia Are at Increased Risk for Progression to Neoplasia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727144253.793531100 ◽

2017 ◽

Author(s):

Pradeep Bhandari ◽

Gaius Longcroft-Wheaton

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Low Grade ◽

Increased Risk ◽

Low Grade Dysplasia

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A population-based study of gastric cancer and Barrett's Esophagus in a rural population in Colombia: Lack of protection by H. Pylori

Gastroenterology ◽

10.1016/s0016-5085(00)81406-7 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1382

Author(s):

Hector Cardona ◽

Oscar Gutierrez ◽

J. Becerra ◽

William Otero ◽

Antonia Sepulveda ◽

...

Keyword(s):

Gastric Cancer ◽

Barrett’S Esophagus ◽

Rural Population ◽

Barrett's Esophagus ◽

Population Based ◽

Population Based Study ◽

H Pylori

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Endoscopic Expert Revision of Previous Histological Confirmed Flat Low-Grade Dysplasia In Barrett’s Esophagus

10.1055/s-0041-1724332 ◽

2021 ◽

Author(s):

EA Nieuwenhuis ◽

SN van Munster ◽

BLAM Weusten ◽

L Alvarez Herrero ◽

A Bogte ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Low Grade ◽

Low Grade Dysplasia

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Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort

Diseases of the Esophagus ◽

10.1093/dote/doz061 ◽

2019 ◽

Cited By ~ 2

Author(s):

K Y Song ◽

A J Henn ◽

A A Gravely ◽

H Mesa ◽

S Sultan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Independent Risk Factor ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Increased Risk ◽

Low Grade Dysplasia

SUMMARY Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24–5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61–13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83–6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03–17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.

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516 THE CHARACTERIZATION OF DYSPLASIA IN BARRETT’S ESOPHAGUS—A PROSPECTIVE NATIONWIDE REGISTRY FROM THE RIBBON NETWORK

Diseases of the Esophagus ◽

10.1093/dote/doaa087.137 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

L O Byrne ◽

M O' Brien ◽

C Muldoon ◽

C Ryan ◽

M Buckley ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Initial Diagnosis ◽

Low Grade ◽

Time To Progression ◽

Female Ratio ◽

Repeat Endoscopy ◽

Ethical Approval ◽

Indefinite For Dysplasia ◽

The Republic

Abstract Barrett’s Esophagus is the main pathological precursor to esophageal adenocarcinoma (EAC), dysplasia is known to be one of the principal predictors of progression to malignancy. The RIBBON Registry was established with six academic medical centers in the Republic of Ireland to identify and manage high risk Barrett’s Esophagus (BE) patients. From our database of over 4,000 patients our aim was to establish characteristics of those patients who progressed to dysplasia and furthermore to malignancy. Methods Data was gathered prospectively from December 2007—December 2019. Ethical approval was sought for the database at the time of establishment. Detailed endoscopic, pathological and clinical data was collected via a web-based data capture system at time of initial diagnosis and at each subsequent encounter. A data manager was appointed at each site and a national lead coordinating the project. The Vienna Grading system was used to grade histology. Patients were included if they had an initial or subsequent diagnosis of Specialized intestinal metaplasia (SIM), Indefinite for dysplasia (IND) or Low-Grade Dysplasia (LGD). Results 860 patients were included with a total of 3792 patient years, a male to female ratio of 2.9:1 and a median age at diagnosis of 63. 50 patients had an initial diagnosis of SIM with subsequent episodes of dysplasia while 510 patients had IND or LGD at diagnosis. 158 (18.37%) progressed to High grade dysplasia (HGD) and EAC. The overall incidence of EAC was 1.7% per year, HGD 2.4% per year and a combined rate of 4.2% per year. Median time to progression in SIM was 4.7 years, 1.1 years for IND and 9 months for LGD. Conclusion The overall progression of the group was much higher compared to looking at those who had SIM alone without dysplasia from the same registry (0.9% per year). Time to progression was significantly faster in the groups with initial dysplasia be that IND or LGD. In our centers those patients were followed up with repeat endoscopy as per international guidelines, the above results highlight the importance of this practice given the potential for malignancy.

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