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The natural history of low-grade dysplasia in Barrett's esophagus and risk factors for progression.
- Source :
-
JGH open : an open access journal of gastroenterology and hepatology [JGH Open] 2021 Aug 06; Vol. 5 (9), pp. 1019-1025. Date of Electronic Publication: 2021 Aug 06 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Background and Aim: Barrett's esophagus is associated with increased risk of esophageal adenocarcinoma. The optimal management of low-grade dysplasia arising in Barrett's esophagus remains controversial. We performed a retrospective study from a tertiary referral center for Barrett's esophagus neoplasia, to estimate time to progression to high-grade dysplasia/esophageal adenocarcinoma in patients with confirmed low-grade dysplasia compared with those with downstaged low-grade dysplasia from index presentation and referral. We analyzed risk factors for progression.<br />Methods: We analyzed consecutive patients with low-grade dysplasia in Barrett's esophagus referred to a single tertiary center (July 2006-October 2018). Biopsies were reviewed by at least two expert pathologists.<br />Results: One hundred and forty-seven patients referred with suspected low-grade dysplasia were included. Forty-two of 133 (32%) of all external referrals had confirmed low-grade dysplasia after expert histopathology review. Multivariable analysis showed nodularity at index endoscopy ( P  < 0.05), location of dysplasia ( P  = 0.05), and endoscopic therapy after referral ( P  = 0.09) were associated with progression risk. At 5 years, 59% of patients with confirmed low-grade dysplasia had not progressed versus 74% of patients in the cohort downstaged to non-dysplastic Barrett's esophagus.<br />Conclusion: Our data show variability in the diagnosis of low-grade dysplasia. The cumulative incidence of progression and time to progression varied across subgroups. Confirmed low-grade dysplasia had a shorter progression time compared with the downstaged group. Nodularity at index endoscopy and multifocal low-grade dysplasia were significant risk factors for progression. It is important to differentiate these high-risk subgroups so that decisions on surveillance/endotherapy can be personalized.<br /> (© 2021 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
Details
- Language :
- English
- ISSN :
- 2397-9070
- Volume :
- 5
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- JGH open : an open access journal of gastroenterology and hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 34584970
- Full Text :
- https://doi.org/10.1002/jgh3.12625