Patients with nondysplastic Barrett's esophagus have low risks for developing dysplasia or esophageal adenocarcinoma.
OBJECTIVE
The risks of dysplasia and esophageal adenocarcinoma (EAC) are not clear for patients with nondysplastic Barrett's esophagus (NDBE); the rate of progression has been overestimated in previous studies. We studied the incidences of dysplasia and EAC and investigated factors associated with progression of BE.


METHODS
The BE study is a multicenter outcomes project of a large cohort of patients with BE. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Patients followed up for at least 1 year after the index endoscopy examination were included, whereas those diagnosed with dysplasia and EAC within 1 year of diagnosis with BE (prevalent cases) were excluded. Of 3334 patients with BE, 1204 met the inclusion criteria (93.7% Caucasian; 88% male; mean age, 59.3 y) and were followed up for a mean of 5.52 years (6644.5 patient-years).


RESULTS
Eighteen patients developed EAC (incidence, 0.27%/y; 95% confidence interval [CI], 0.17-0.43) and 32 developed HGD (incidence, 0.48%/y; 95% CI, 0.34-0.68). The incidence of HGD and EAC was 0.63%/y (95% CI, 0.47-0.86). There were 217 cases of low-grade dysplasia (incidence, 3.6%/y; 95% CI, 3.2-4.1). Five and 10 years after diagnosis, 98.6% (n = 540) and 97.1% (n = 155) of patients with NDBE were cancer free, respectively. The length of the BE was associated significantly with progression (EAC <6 cm, 0.09%/y vs EAC ≥ 6 cm, 0.65%/y; P = 0.001).


CONCLUSIONS
There is a lower incidence of dysplasia and EAC among patients with NDBE than previously reported. Because most patients are cancer free after a long-term follow-up period, surveillance intervals might be lengthened, especially for patients with shorter segments of BE.
Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
Sachin
S
Wani
Gary
G
Falk
Matthew
M
Hall
Srinivas
S
Gaddam
Amy
A
Wang
Neil
N
Gupta
Mandeep
M
Singh
Vikas
V
Singh
Keng-Yu
KY
Chuang
Vikram
V
Boolchand
Hemanth
H
Gavini
John
J
Kuczynski
Priti
P
Sud
Savio
S
Reddymasu
Ajay
A
Bansal
Amit
A
Rastogi
Sharad C
SC
Mathur
Patrick
P
Young
Brooks
B
Cash
David A
DA
Lieberman
Richard E
RE
Sampliner
Prateek
P
Sharma
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications*; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006651:Histocytochemistry; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis