Barrett's esophagus: data support surveillance for indefinite dysplasia

  • Krishnamoorthi R & al.
  • Gastrointest Endosc
  • 14 Aug 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • In Barrett's esophagus, risk for progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) with indefinite dysplasia (BE-IND) is similar to that previously reported for low-grade dysplasia (BE-LGD).

Why this matters

  • Findings support guidelines from the American College of Gastroenterology for endoscopic surveillance of BE-IND every 12 months, which were based on expert opinion.

Study design

  • Meta-analysis of 8 studies of patients with BE-IND (n=1441).
  • Funding: None disclosed.

Key results

  • HGD and/or EAC pooled incidence, 1.5 (95% CI, 1.0-2.0) per 100 person-years during 5306.2 person-years of follow-up (moderate heterogeneity, I2=56.5%).
    • HGD and/or EAC risk estimate for BE-LGD, 0.5%.
  • EAC pooled incidence, 0.6 (95% CI, 0.1-1.1) per 100 person-years (considerable heterogeneity, I2=89.0%).
    • EAC risk estimate for BE-LGD, 1.7%.
  • EAC frequency was higher in Europe than North America (0.9% vs 0.1%; P=.01).
  • Pooled incidence of LGD in BE-IND was 11.4 per 100 person-years (95% CI, 0.06-0.2; I2=83.6%).

Limitations

  • Meta-analysis assumed constant incidence rate.
  • Possible misclassification bias in the included studies.

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