Risk stratification for malignant progression in Barrett's esophagus: Gender, age, duration and year of surveillance

AIM To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.METHODS Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were(1) development of all grades of dysplasia;(2) development of high-grade of dysplasia or adenocarcinoma; and(3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.RESULTS One thousand and one hundred thirty six patients were included(total 6474 patient-years). Fifty-four patients developed adenocarcinoma(0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma(1.1% per annum) and 190 developed any grade of dysplasia(3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.CONCLUSION The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus

AIM:To investigate the lifetime risk of development of esophageal adenocarcinoma and/or high-grade dysplasia in patients diagnosed with Barrett’s esophagus.METHODS:Data were extracted from the United Kingdom National Barrett’s Oesophagus Registry on date of diagnosis,patient age and gender of 7877 patients from who had been registered from 35 United Kingdom centers.Life expectancy was evaluated from United Kingdom National Statistics data based upon gender and age at year at diagnosis.These data were then used with published estimates of annual adenocarcinoma and high-grade dysplasia incidences from metaanalyses and large population-based studies to estimate overall lifetime risk of development of these study endpoints.RESULTS:The mean age at diagnosis of Barrett’s esophagus was 61.6 years in males and 67.3 years in females.The mean life expectancy at diagnosis was23.1 years in males,20.7 years in females and 22.2years overall.Using data from published meta-analyses,the lifetime risk of development of adenocarcinoma was between 1 in 8 and 1 in 14 and the lifetime risk of high-grade dysplasia or adenocarcinoma was 1 in 5 to1 in 6.Using data from 3 large recent population-based cohort studies the lifetime risk of adenocarcinoma was between 1 in 10 and 1 in 37 and of the combined endpoint of high-grade dysplasia and adenocarcinoma was between 1 in 8 and 1 in 20.Age at Barrett’s esophagus diagnosis is reducing and life expectancy is increasing,which will partially counter-balance lower annual cancer incidence.CONCLUSION:There is a significant lifetime risk of development of high-grade dysplasia and adenocarcinoma in Barrett’s esophagus.