1. Outcomes of patients with Barrett's oesophagus with low-grade dysplasia undergoing endoscopic surveillance in a tertiary centre: a retrospective cohort study.
- Author
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Vlismas LJ, Potter M, Loewenthal MR, Wilson K, Allport K, Gillies D, Cook D, Philcox S, Bollipo S, and Talley NJ
- Subjects
- Humans, Male, Retrospective Studies, Female, Middle Aged, Aged, Cohort Studies, Population Surveillance methods, Aged, 80 and over, Precancerous Conditions pathology, Precancerous Conditions epidemiology, Adult, Risk Factors, Follow-Up Studies, Australia epidemiology, Barrett Esophagus pathology, Barrett Esophagus epidemiology, Barrett Esophagus diagnosis, Tertiary Care Centers, Esophageal Neoplasms pathology, Esophageal Neoplasms epidemiology, Esophageal Neoplasms diagnosis, Esophagoscopy, Disease Progression, Adenocarcinoma pathology, Adenocarcinoma epidemiology, Adenocarcinoma diagnosis
- Abstract
Background and Aim: Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression., Methods: Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed., Results: Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3-12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9-22.8; P = 0.003)., Conclusion: Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined., (© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)
- Published
- 2024
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