Risk of Malignant Progression in Barrett’s Esophagus Patients: Results from a Large Population-Based Study
Shivaram Bhat,Helen G. Coleman,Fouad Yousef,Brian T. Johnston,Damian T. McManus,Anna Gavin,Liam J. Murray +6 more
TLDR
The risk of malignant progression among patients with BE is found to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective.Abstract:
the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett’s esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005. Subjects and We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without Methods specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General’s Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 personyears (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests. Results After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P < .001), in men compared with women (0.28% per year vs 0.13% per year; HR = 2.11, 95% CI = 1.41 to 3.16, P < .001), and in patients with low-grade dysplasia compared with no dysplasia (1.40% per year vs 0.17% per year; HR = 5.67, 95% CI = 3.77 to 8.53, P < .001). Conclusion We found the risk of malignant progression among patients with BE to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective.read more
Citations
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Journal ArticleDOI
ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus
TL;DR: Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma, and endoscopic surveillance intervals are attenuated, based on recent level 1 evidence.
Journal ArticleDOI
Incidence of Adenocarcinoma among Patients with Barrett's Esophagus
Frederik Hvid-Jensen,Lars Pedersen,Asbjørn Mohr Drewes,Henrik Toft Sørensen,Peter Funch-Jensen +4 more
TL;DR: Barrett's esophagus is a strong risk factor for esophageal adenocarcinoma, but the absolute annual risk, 0.12%, is much lower than the assumed risk of 0.5%, which is the basis for current surveillance guidelines.
Journal ArticleDOI
British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus
Rebecca C. Fitzgerald,Massimiliano di Pietro,Krish Ragunath,Yeng Ang,Jin-Yong Kang,Peter H. Watson,Nigel Trudgill,Praful Patel,Philip Kaye,Scott Sanders,M O'Donovan,Elizabeth L. Bird-Lieberman,Pradeep Bhandari,Janusz Jankowski,Stephen Attwood,Simon L. Parsons,Duncan Loft,Jesper Lagergren,Paul Moayyedi,Georgios Lyratzopoulos,John de Caestecker +20 more
TL;DR: These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia and suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria for the first time.
Journal ArticleDOI
Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia: A Randomized Clinical Trial
K. Nadine Phoa,Frederike G. Van Vilsteren,Bas L. Weusten,Raf Bisschops,Erik J. Schoon,Krish Ragunath,Grant Fullarton,Massimiliano di Pietro,Narayanasamy Ravi,Mike Visser,G. Johan A. Offerhaus,Cees A. Seldenrijk,Sybren L. Meijer,Fiebo J.W. ten Kate,Jan G.P. Tijssen,Jacques J. Bergman +15 more
TL;DR: Radiofrequency ablation resulted in a reduced risk of neoplastic progression over 3 years of follow-up and the data and safety monitoring board recommended early termination of the trial due to superiority of ablation for the primary outcome and the potential for patient safety issues if the trial continued.
Journal ArticleDOI
The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis
Tusar K. Desai,Kumar Krishnan,Niharika Samala,Jashanpreet Singh,John D. Cluley,Subaiah Perla,Colin W. Howden +6 more
TL;DR: The incidence of OAC in non-dysplastic Barrett's oesophagus in patients with BO without dysplasia is around 1 per 300 patients per year, and the incidence in short-segment BO is under 1 per 500 patients peryear.
References
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Journal ArticleDOI
Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus.
TL;DR: The guidelines for the diagnosis, surveillance and therapy of Barrett’s esophagus were originally published by the American College of Gastroenterology in 1998 and updated in 2002 and once again reviewed using the National Library of Medicine database.
Journal ArticleDOI
Is there publication bias in the reporting of cancer risk in Barrett's esophagus?
TL;DR: There was a strong correlation between cancer risk and the size of the study, with small studies reporting much higher risks of cancer than larger studies, and publication bias may be overestimated in the literature due to publication bias.
Journal ArticleDOI
The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett
Stuart J. Spechler,Raj K. Goyal +1 more
Journal ArticleDOI
The Incidence of Esophageal Cancer and High-Grade Dysplasia in Barrett's Esophagus: A Systematic Review and Meta-Analysis
Fouad Yousef,Christopher Cardwell,Marie M. Cantwell,Karen Galway,Brian T. Johnston,Liam J. Murray +5 more
TL;DR: The pooled estimates of cancer and HGD incidence were low, suggesting that the cost-effectiveness of surveillance is questionable unless it can be targeted to those with the highest cancer risk.
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