title: A Barrett's esophagus registry of over 1000 patients from a specialist center highlights greater risk of progression than population-based registries and high risk of low grade dysplasia.
abstract: Barrett's esophagus (BE) arising from chronic gastro-oesophageal reflux (GERD) is the main pathologic precursor of esophageal adenocarcinoma (EAC). The risk of progression to high-grade dysplasia (HGD) and EAC is unclear, and recent population studies from Denmark and Northern Ireland suggest that this has been overestimated in the past. No data exist from the Republic of Ireland. A detailed clinical, endoscopic, and pathologic database was established in one center as a proposed pilot for a national registry, and initial and follow-up data were abstracted by a data manager. One thousand ninety-three patients were registered, 60 patients with HGD were excluded, leaving 1033, with a median age of 59 and 2 : 1 male to female ratio, and 3599 person-years of follow-up. The overall incidence of HGD/EAC was 1.33% per year overall, 0.85% if the first year is excluded. Within the first year after index endoscopy, 18 cases of HGD or EAC were identified, and 30 following the first year. Low-grade dysplasia (LGD) on index endoscopy was associated with an incidence of progression of 6.5% per year, and 3.1% when tertiary referrals were excluded. These data provide important demographic and clinical information on the population of Irish patients with BE, with incidence rates of progression higher than recently published population-based registry series, perhaps relating to sampling and pathological assessment. Low-grade dysplasia on initial biopsy is a significant proxy marker of risk of progression.
authors.affiliation: Department of Surgery, Trinity Center for Health Sciences, St. James's Hospital and Trinity College Dublin, Dublin, Ireland.
authors.forename: S L
authors.initials: SL
authors.lastname: Picardo
authors.forename: M P
authors.initials: MP
authors.lastname: O'Brien
authors.forename: R
authors.initials: R
authors.lastname: Feighery
authors.forename: D
authors.initials: D
authors.lastname: O'Toole
authors.forename: N
authors.initials: N
authors.lastname: Ravi
authors.forename: N J
authors.initials: NJ
authors.lastname: O'Farrell
authors.forename: J N
authors.initials: JN
authors.lastname: O'Sullivan
authors.forename: J V
authors.initials: JV
authors.lastname: Reynolds
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology; D001706:Biopsy / Q000706:statistics & numerical data; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D017678:Sex Distribution
keywords: Barrett's esophagus; esophageal adenocarcinoma; high-grade dysplasia; low-grade dysplasia