Routinely diagnosed low-grade dysplasia in Barrett's oesophagus: a population-based study of natural history.
OBJECTIVE
To examine the natural history of columnar-lined oesophagus with routinely diagnosed low-grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development.


RESULTS
A multicentre retrospective cohort study of 283 patients with low-grade dysplasia. Follow-up data were obtained from examination of hospital records. One hundred and forty-four patients had biopsies prior to low-grade dysplasia diagnosis and 217 had follow-up biopsies after index low-grade dysplasia diagnosis. In these patients the incidence of high-grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow-up, 43 (19.8%) had persistent low-grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non-dysplastic columnar-lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low-grade dysplasia diagnosis), the annual incidence of high-grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low-grade dysplasia compared with non-dysplastic columnar-lined oesophagus was 2.871 (P = 0.002).


CONCLUSIONS
Low-grade dysplasia has a threefold increased risk of progression to cancer compared with non-dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.
Gatenby
Piers
P
UK National Barrett's Oesophagus Registry, University Department of Surgery, Royal Free and University College Medical School, London, UK. p.gatenby@ucl.ac.uk
Ramus
James
J
Caygill
Christine
C
Shepherd
Neil
N
Winslet
Marc
M
Watson
Anthony
A
D000230:Adenocarcinoma / Q000209:etiology; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D004848:Epithelium / Q000473:pathology; D004938:Esophageal Neoplasms / Q000209:etiology; D004945:Esophagoscopy; D005500:Follow-Up Studies; D006801:Humans; D008679:Metaplasia; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D006113:United Kingdom