title: Predictors of Progression in Barrett's Esophagus with Low-Grade Dysplasia: Results from a Multicenter Prospective BE Registry.
abstract: OBJECTIVE
  Low-grade dysplasia (LGD) is a risk factor for progression in Barrett's esophagus (BE). Progression estimates however vary and predictors of progression are not well established. We aimed to assess predictors of progression in a multicenter BE-LGD cohort.
  
  
  METHODS
  All subjects with LGD (diagnosed by a GI pathologist) in a prospective BE registry were identified. Progression was defined development of HGD/EAC more than 12 months after index date of LGD diagnosis. Clinical, endoscopic factors and impact of histologic review by an independent panel of two GI pathologists were assessed as predictors of progression. Cox proportional hazard models were used to assess their association with risk of progression.
  
  
  RESULTS
  244 BE-LGD subjects met inclusion criteria. Their mean age was 63.2 years. 205 (84%) were males. The median follow up was 4.8 years. Fifty six patients were diagnosed with HGD/EAC in less than 12 months, while 14 progressed to HGD/EAC after 12 months, with an overall annual risk of progression of 1.2%. 29% of LGD subjects were downgraded to non-dysplastic and the remaining re-confirmed as LGD or indefinite dysplasia. The risk of progression in the reconfirmed LGD group was eight fold higher (hazards ratio: 7.6, 95% CI: 1.5-139.4) in a propensity score stratified model.
  
  
  CONCLUSIONS
  In this large BE-LGD cohort, progression risk increased substantially when an additional panel of two expert GI pathologists re-confirmed a LGD diagnosis. These BE subjects may be candidates for endoscopic therapy. LGD was a marker of prevalent HGD/EAC in 18% of patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamoorthi
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lewis
authors.affiliation: Division of Anatomic Pathology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Murli
authors.initials: M
authors.lastname: Krishna
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Crews
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Dierkhising
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Brenda F
authors.initials: BF
authors.lastname: Ginos
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Fleischer
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA.
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Ramirez
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Buttar
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D057216:Propensity Score; D012042:Registries; D012307:Risk Factors