title: Low Risk of High-Grade Dysplasia or Esophageal Adenocarcinoma Among Patients With Barrett's Esophagus Less Than 1 cm (Irregular Z Line) Within 5 Years of Index Endoscopy.
abstract: Many patients with a < 1 cm segment of columnar metaplasia in the distal esophagus, also called an irregular Z line, are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia.
  
  
  
  We performed a prospective, multicenter cohort study of patients who underwent endoscopic examination for BE at tertiary care referral centers in the United States and Europe. We analyzed data from 1791 patients (mean age, 56 ± 17 years) found to have non-dysplastic BE at the index endoscopy and after 1 year or more of follow-up. Patients were followed for a median of 5.9 years (interquartile range, 3.1-8.3 years). We calculated rates of progression to HGD or EAC between groups of patients with irregular Z line (n = 167) and those with BE of ≥ 1 cm (n = 1624).
  
  
  
  A higher proportion of patients in the irregular Z-line group were female (26.3%) than in the BE group (14.8% female BE) (P <.001). A lower proportion of patients in the irregular Z-line group were smokers (33.5%) than in the BE group (52.6% smokers). None of the patients with irregular Z line developed HGD or EAC during a median follow-up period of 4.8 years (interquartile range, 3.2-8.3 years). All 71 incident cases of HGD or EAC developed in patients with BE of ≥1 cm in length. On multivariate analysis, patients with irregular Z line and patients with BE of ≥ 1 cm did not differ significantly in age, race, or duration of follow-up.
  
  
  
  In a prospective, multicenter cohort study, we found that patients with irregular Z line do not develop HGD or esophageal cancer within 5 years after index endoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio. Electronic address: thotap@ccf.org.
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vennalaganti
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
authors.forename: Sreekar
authors.initials: S
authors.lastname: Vennelaganti
authors.affiliation: Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Young
authors.affiliation: Department of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.affiliation: Department of Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, Illinois.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon.
authors.forename: David
authors.initials: D
authors.lastname: Lieberman
authors.affiliation: Department of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona.
authors.forename: Richard
authors.initials: R
authors.lastname: Sampliner
authors.affiliation: Department of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
authors.forename: Sharad
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kennedy
authors.affiliation: Department of Gastroenterology and Hepatology, University of South Alabama, Mobile, Alabama.
authors.forename: Brooks D
authors.initials: BD
authors.lastname: Cash
authors.affiliation: Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Fouad
authors.initials: F
authors.lastname: Moawad
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands.
authors.forename: Manon C
authors.initials: MC
authors.lastname: Spaander
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands.
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas; Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011230:Precancerous Conditions / Q000453:epidemiology* / Q000473:pathology; D011446:Prospective Studies; D012306:Risk; D047368:Tumor Burden
keywords: Cancer Detection; Population; Screening; Tumorigenesis