Barrett esophagus: risk factors for progression to dysplasia and adenocarcinoma.
OBJECTIVE
To evaluate risk factors for dysplasia and adenocarcinoma development in nondysplastic Barrett mucosa.


BACKGROUND
The risk for patients with Barrett esophagus to develop esophageal adenocarcinoma is low, and most patients undergoing surveillance will not develop malignancy. Identification of risk factors may allow for more rational surveillance programs in which patients are stratified according to their individual risk of progressing to dysplasia and invasive adenocarcinoma.


METHODS
The development of dysplasia and esophageal adenocarcinoma was studied during long-term endoscopic and histologic surveillance in 140 patients with Barrett esophagus free from dysplasia. Risk factors for progression to dysplasia and adenocarcinoma were evaluated.


RESULTS
Median follow-up was 5.8 years. Forty-four patients (31.4%) developed low-grade dysplasia and 7 patients (5%) developed high-grade dysplasia or esophageal adenocarcinoma. Dysplasia development was significantly less common after antireflux surgery compared with conventional medical therapy. Low-grade dysplasia (relative risk = 5.5; 95% confidence interval, 1.1-28.6) and long duration of reflux symptoms (relative risk = 1.3; 95% confidence interval, 1.2-1.7) were independently associated with an increased risk of developing high-grade dysplasia or esophageal adenocarcinoma.


CONCLUSIONS
Successful antireflux surgery protects the Barrett mucosa from developing high-grade dysplasia and esophageal adenocarcinoma, possibly by better control of reflux of gastric contents. Low-grade dysplasia is the only clinically useful risk factor that permits stratification of the surveillance intervals according to the risk of the individual patient.
Department of Surgery, Lund University Hospital, Lund, Sweden. stefan.oberg@kir.lu.se
Stefan
S
Oberg
Jörgen
J
Wenner
Jan
J
Johansson
Bruno
B
Walther
Roger
R
Willén
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric