title: Surveillance and follow-up strategies in patients with high-grade dysplasia in Barrett's esophagus: a Dutch population-based study.
abstract: OBJECTIVE
  In patients with high-grade dysplasia (HGD) in Barrett's esophagus (BE), it is incompletely known which factors are associated with developing esophageal adenocarcinoma (EAC). We analyzed prior biopsy and follow-up strategies in a large nationwide population-based cohort of patients with HGD in BE, and identified predictors of EAC progression.
  
  
  METHODS
  Prior biopsy records and follow-up evaluations were studied in patients with HGD in BE diagnosed between 1999 and 2008, using PALGA, a nationwide network and registry of histopathology and cytopathology in the Netherlands. Multivariate Cox proportional hazards regression analysis was performed to identify predictors for prevalent (≤ 6 months) and incident (> 6 months) EAC.
  
  
  RESULTS
  In total, 827 patients with HGD in BE were included. Follow-up data after HGD diagnosis were available in 699 (85%) patients. In 249 (36%) of these patients, an EAC was detected (14.1 EACs per 100 person-years). The risk of prevalent EAC (n=177) was lower with previous surveillance (hazards ratio 0.7; 95% confidence interval 0.5-0.9), unifocal HGD (0.3;0.2-0.6), diagnosis in a university hospital (0.5;0.3-0.9), endoscopic resection (0.5;0.3-0.7), or ablation (0.0;0.0-0.3); and higher when patients were 65-75 years (1.5;1.04-2.04). After exclusion of prevalent EACs, the progression rate was 4.2 EACs per 100 person-years. The risk of progression to incident EAC (n = 72) was lower with previous surveillance (0.6;0.3-0.9) and ablation (0.2;0.0-0.8), and higher when > 75 years (3.8;2.0-7.2) or with an interval > 6 months between HGD diagnosis and first follow-up (e.g., 7-12 months 2.9;1.3-6.3).
  
  
  CONCLUSIONS
  In this cohort of patients with HGD in BE, the EAC detection rate was 14.1 per 100 person-years and 4.2 per 100 person-years after excluding prevalent cases. The risk of both prevalent and incident EAC was reduced with previous surveillance and endoscopic treatment, while it was increased with older age.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. r.e.verbeek-2@umcutrecht.nl
authors.forename: Romy E
authors.initials: RE
authors.lastname: Verbeek
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Frank P
authors.initials: FP
authors.lastname: Vleggaar
authors.forename: Marguerite E I
authors.initials: ME
authors.lastname: Schipper
authors.forename: Mariel K
authors.initials: MK
authors.lastname: Casparie
authors.forename: Jantine W P M
authors.initials: JW
authors.lastname: van Baal
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology*; D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis