title: Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis.
abstract: BACKGROUND
  The natural history of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE) is unclear.
  
  
  OBJECTIVE
  We performed a systematic review and meta-analysis of studies that reported the incidence of esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) among patients with BE with LGD.
  
  
  METHODS
  Systematic review and meta-analysis of cohort studies.
  
  
  METHODS
  Patients with BE-LGD, with mean cohort follow-up ≥ 2 years.
  
  
  METHODS
  Pooled incidence rates with 95% confidence intervals (CI) of EAC and/or BE-HGD.
  
  
  RESULTS
  We identified 24 studies reporting on 2694 patients with BE-LGD, with 119 cases of EAC. Pooled annual incidence rates of EAC alone and EAC and/or HGD in patients with BE-LGD were 0.54% (95% CI, 0.32-0.76; 24 studies) and 1.73% (95% CI, 0.99-2.47; 17 studies). The results were stable across study setting and location and in high-quality studies. Substantial heterogeneity was observed, which could be explained by stratifying based on LGD/BE ratio as a surrogate for quality of pathology; the pooled annual incidence rates of EAC were 0.76% (95% CI, 0.44-1.09; 14 studies) for LGD/BE ratio <0.15 and 0.32% (95% CI, 0.07-0.58; 10 studies) for LGD/BE ratio >0.15. The annual rate of mortality not related to esophageal disease in patients with BE-LGD was 4.7% (95% CI, 3.2-6.2; 4 studies).
  
  
  CONCLUSIONS
  Substantial heterogeneity was observed in the overall analysis.
  
  
  CONCLUSIONS
  The incidence of EAC among patients with BE-LGD is 0.54% annually. The LGD/BE ratio appears to explain the variation observed in the reported incidence of EAC in different cohorts. Conditions not related to esophageal disease are a major cause of mortality in patients with BE-LGD, although additional studies are warranted.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, William Beaumont Hospital/Oakland University School of Medicine, Royal Oak, Michigan, USA.
authors.forename: Palaniappan
authors.initials: P
authors.lastname: Manickam
authors.affiliation: Department of Internal Medicine, William Beaumont Hospital/Oakland University School of Medicine, Royal Oak, Michigan, USA.
authors.forename: Anita V
authors.initials: AV
authors.lastname: Amin
authors.affiliation: Department of Internal Medicine, William Beaumont Hospital/Oakland University School of Medicine, Royal Oak, Michigan, USA.
authors.forename: Niharika
authors.initials: N
authors.lastname: Samala
authors.affiliation: Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, The Netherlands.
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schouten
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
authors.affiliation: Department of Internal Medicine, William Beaumont Hospital/Oakland University School of Medicine, Royal Oak, Michigan, USA.
authors.forename: Tusar K
authors.initials: TK
authors.lastname: Desai
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D001471:Barrett Esophagus / Q000150:complications / Q000209:etiology / Q000473:pathology; D004938:Esophageal Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D014943:Global Health; D006801:Humans; D015994:Incidence