title: Association between length of Barrett's esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia.
abstract: OBJECTIVE
  It is not clear whether length of Barrett's esophagus (BE) is a risk factor for high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with nondysplastic BE. We studied the risk of progression to HGD or EAC in patients with nondysplastic BE, based on segment length.
  
  
  METHODS
  We analyzed data from a large cohort of patients participating in the BE Study-a multicenter outcomes project comprising 5 US tertiary care referral centers. Histologic changes were graded as low-grade dysplasia, HGD, or EAC. The study included patients with BE of documented length without dysplasia and at least 1 year of follow-up evaluation (n = 1175; 88% male), and excluded patients who developed HGD or EAC within 1 year of their BE diagnosis. The mean follow-up period was 5.5 y (6463 patient-years). The annual risk of HGD and EAC was plotted in 3-cm increments (≤3 cm, 4-6 cm, 7-9 cm, 10-12 cm, and ≥13 cm). We calculated the association between time to progression and length of BE.
  
  
  RESULTS
  The mean BE length was 3.6 cm; 44 patients developed HGD or EAC, with an annual incidence rate of 0.67%/y. Compared with nonprogressors, patients who developed HGD or EAC had longer BE segments (6.1 vs 3.5 cm; P < .001). Logistic regression analysis showed a 28% increase in risk of HGD or EAC for every 1-cm increase in BE length (P = .01). Patients with BE segment lengths of 3 cm or shorter took longer to develop HGD or EAC than those with lengths longer than 4 cm (6 vs 4 y; P = nonsignificant).
  
  
  CONCLUSIONS
  In patients with BE without dysplasia, length of BE was associated with progression to HGD or EAC. The results support the development of a risk stratification scheme for these patients based on length of BE segment.
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri.
authors.forename: Rajeswari
authors.initials: R
authors.lastname: Anaparthy
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Vijay
authors.initials: V
authors.lastname: Kanakadandi
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Alsop
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: April D
authors.initials: AD
authors.lastname: Higbee
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Wani
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Young
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Prashanti
authors.initials: P
authors.lastname: Thota
authors.forename: Richard E
authors.initials: RE
authors.lastname: Sampliner
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D062606:Tertiary Care Centers; D014481:United States
keywords: BE; BEST Study; Barrett's esophagus; CI; EAC; Esophageal Cancer; HGD; Intestinal Metaplasia; LGD; NDBE; NSAID; PPI; SD; Screening; Surveillance; confidence interval; esophageal adenocarcinoma; high-grade dysplasia; low-grade dysplasia; nondysplastic Barrett's esophagus; nonsteroidal anti-inflammatory drug; proton pump inhibitor; standard deviation