title: Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for esophageal adenocarcinoma: results from a large multicenter cohort.
abstract: OBJECTIVE
  Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE).
  
  
  METHODS
  We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer.
  
  
  RESULTS
  Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3% white; 87.5% men; median age, 60 ±17 years). The median follow-up period was 5 ± 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively (P for trend = .03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC.
  
  
  CONCLUSIONS
  Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.
authors.affiliation: Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Gokulakrishnan
authors.initials: G
authors.lastname: Balasubramanian
authors.forename: Prashanthi
authors.initials: P
authors.lastname: Thota
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: April D
authors.initials: AD
authors.lastname: Higbee
authors.forename: Sharad C
authors.initials: SC
authors.lastname: Mathur
authors.forename: John D
authors.initials: JD
authors.lastname: Horwhat
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Young
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.forename: Richard E
authors.initials: RE
authors.lastname: Sampliner
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000473:pathology*; D012306:Risk
keywords: BE; Barrett's Esophagus; Barrett's esophagus; CI; Dysplasia; EAC; EGD; Esophageal Adenocarcinoma; HGD; IQR; LGD; NDBE; OR; PPI; Risk; confidence interval; esophageal adenocarcinoma; esophagogastroduodenoscopy; high-grade dysplasia; interquartile range; low-grade dysplasia; nondysplastic Barrett's esophagus; odds ratio; proton pump inhibitor