title: Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study.
abstract: OBJECTIVE
  Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy.
  
  
  METHODS
  Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated.
  
  
  RESULTS
  Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar.
  
  
  CONCLUSIONS
  Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Preetika
authors.initials: P
authors.lastname: Sinh
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Rajeswari
authors.initials: R
authors.lastname: Anaparthy
authors.affiliation: Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Young
authors.affiliation: Department of Gastroenterology, Washington University in St. Louis, St Louis, Missouri, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Prashanthi
authors.initials: P
authors.lastname: Thota
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Gokulakrishnan
authors.initials: G
authors.lastname: Balasubramanian
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: April D
authors.initials: AD
authors.lastname: Higbee
authors.affiliation: Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology, Loyola University, Maywood, Illinois, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Pathology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Sharad C
authors.initials: SC
authors.lastname: Mathur
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Horwhat
authors.affiliation: Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Pathology, University of Arizona Cancer Center, Tucson, Arizona, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Sampliner
authors.affiliation: Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D001471:Barrett Esophagus / Q000150:complications* / Q000175:diagnosis; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions; D013997:Time Factors; D014481:United States / Q000453:epidemiology