Patients With Barrett's Esophagus and Confirmed Persistent Low-grade Dysplasia at Increased Risk for Progression to Neoplasia.
Duits LC, van der Wel MJ, Cotton CC, Phoa KN, Ten Kate FJ, Seldenrijk CA, Offerhaus GJ, Visser M, Meijer SL, Mallant-Hent RC, Krishnadath KK, Pouw RE, Tijssen JG, Shaheen NJ, Bergman JJ.
Gastroenterology. 2016 Dec 21. pii: S0016-5085(16)35506-8. doi: 10.1053/j.gastro.2016.12.008. [Epub ahead of print]
BACKGROUND & AIMS:
For patients with Barrett's esophagus (BE), the diagnosis of low-grade dysplasia (LGD) is subjective and reported outcomes vary. We analyzed data from a multicenter study of endoscopic therapy to identify factors associated progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with LGD of the esophagus.
We performed a retrospective analysis of data from 255 patients with a primary diagnosis of LGD (78% men; mean age, 63 years) who participated in a randomized controlled trial of surveillance vs radiofrequency ablation in Europe. Three expert pathologists independently reviewed baseline and subsequent LGD specimens. The presence and degree of dysplasia was separately recorded for each biopsy and classified according to the Vienna classification system. The primary endpoint was development of HGD or EAC. We performed univariate logistic regression analyses to assess the association between outcome and factors such as number of pathologists confirming LGD, multi-focality of LGD, and persistence of LGD over time.
Of the 255 patients, 45 (18%) developed HGD or EAC during a median 42-month follow-up period (inter-quartile range, 25-61 months); patients were examined by a median 4 endoscopies (inter-quartile range, 3-6 endoscopies). The number of pathologists confirming LGD was strongly associated with progression to neoplasia; risk for progression increased greatly when all 3 pathologists agreed on LGD (odds ratio [OR], 47.14; 95% CI, 13.10-169.70). When LGD was detected at baseline and confirmed by a subsequent endoscopy, the odds for progression to neoplasia also greatly increased (OR, 9.28; 95% CI, 4.39-19.64). Multi-focal LGD was not significantly associated with progression to neoplasia.
The number of pathologists confirming LGD and persistence of LGD over time increase risk for development of HGD or EAC in patients with BE and LGD. These simple, readily available variables can help stratify risk and select patients for prophylactic ablation therapy.