TY - JOUR
T1 - The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia
T2 - a multicenter cohort study
AU - Phillips, Richard
AU - Januszewicz, Wladyslaw
AU - Pilonis, Nastazja D.
AU - O'Donovan, Maria
AU - Sawas, Tarek
AU - Katzka, David A.
AU - Fitzgerald, Rebecca C.
AU - di Pietro, Massimiliano
N1 - Funding Information:
This study received infrastructure support from the National Institute for Health Research and Cambridge Biomedical Research Centre. We would like to thank Tara Evans, Bincy Alias, and Michele Bianchi (MRC Cancer Unit) as well as the staff at the Cambridge Clinical Research Centre for their help with patient management. We would like to thank Calvin Cheah and Ioanna Karouzou for their help with the research database. DISCLOSURE: M. O'Donovan, R. Fitzgerald: named on patents related to the Cytosponge/TFF3, licensed by the MRC to Medtronic; co-founders, with equity, of CYTED Ltd. All authors disclosed no financial relationships.
Funding Information:
This study received infrastructure support from the National Institute for Health Research and Cambridge Biomedical Research Centre . We would like to thank Tara Evans, Bincy Alias, and Michele Bianchi (MRC Cancer Unit) as well as the staff at the Cambridge Clinical Research Centre for their help with patient management. We would like to thank Calvin Cheah and Ioanna Karouzou for their help with the research database.
Publisher Copyright:
© 2021 American Society for Gastrointestinal Endoscopy
PY - 2021/8
Y1 - 2021/8
N2 - Background and Aims: Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND. Methods: Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression. Results: Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016). Conclusion: Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted.
AB - Background and Aims: Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND. Methods: Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of ≥1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression. Results: Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia (27 LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P = .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P = .016). Conclusion: Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted.
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U2 - 10.1016/j.gie.2021.01.042
DO - 10.1016/j.gie.2021.01.042
M3 - Article
C2 - 33548281
AN - SCOPUS:85112119971
SN - 0016-5107
VL - 94
SP - 263-270.e2
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 2
ER -