Does Risk of Progression from Barrett's Esophagus to Esophageal Adenocarcinoma Change Based on the Number of Non-dysplastic Endoscopies?
BACKGROUND
There is a large Barrett's esophagus patient population undergoing endoscopic surveillance. Methods to stratify patients into higher and lower risk groups may enable more varied surveillance intervals for patients with non-dysplastic Barrett's esophagus that could optimize use of endoscopy resources.


OBJECTIVE
We aimed to assess whether risk of progression to esophageal adenocarcinoma differed in patients with multiple endoscopic biopsies negative for dysplasia.


METHODS
We conducted a retrospective cohort study among individuals from the population-based Northern Ireland Barrett's register with a histologically confirmed diagnosis of non-dysplastic Barrett's esophagus (with intestinal metaplasia) between 1993 and 2010, who had at least one endoscopic biopsy conducted at least 12 months after diagnosis. We used Poisson regression to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for the association between number of successive endoscopies showing non-dysplastic Barrett's esophagus and risk of esophageal adenocarcinoma alone, and combined with high-grade dysplasia, at the next endoscopy.


RESULTS
We identified 1761 individuals who met our eligibility criteria. Subsequent risk of progression to esophageal adenocarcinoma was lower at the next endoscopy following two endoscopies showing non-dysplastic Barrett's esophagus (IRR 0.26, 95% CI 0.10-0.66) than following one endoscopy showing non-dysplastic Barrett's esophagus. Similar findings were apparent for risk of progression to esophageal adenocarcinoma or high-grade dysplasia (IRR 0.41, 95% CI 0.22-0.79).


CONCLUSION
The lower risk of malignant progression in individuals with persistent non-dysplastic Barrett's esophagus over two consecutive endoscopic biopsies but not for longer term persistence does not support hypotheses of persistence being an indicator of less biologically aggressive lesions. Instead, the initial difference may be attributable to post-endoscopy cancers and support the necessity of adhering to robust quality standards for endoscopic procedures.
['Kunzmann|Andrew T|AT|0000-0001-9363-566X', 'Coleman|Helen G|HG|', 'Johnston|Brian T|BT|', 'Turkington|Richard C|RC|', 'McManus|Damian|D|', 'Anderson|Lesley A|LA|', 'Thrift|Aaron P|AP|']
D000230:Adenocarcinoma D000368:Aged D001471:Barrett Esophagus D015331:Cohort Studies D018450:Disease Progression D004938:Esophageal Neoplasms D004945:Esophagoscopy D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D012042:Registries D012189:Retrospective Studies D012307:Risk Factors
Esophageal adenocarcinoma Endoscopic surveillance Barrett’s esophagus Epidemiology