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Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis

  • Amit Rastogi
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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  • Srinivas Puli
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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  • Hashem B. El-Serag
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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  • Ajay Bansal
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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  • Sachin Wani
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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  • Prateek Sharma
    Correspondence
    Reprint requests: Prateek Sharma, MD, Gastroenterology Section-111, University of Kansas School, VA Medical Center, 4801 E. Linwood Blvd, Kansas City, MO 64128.
    Affiliations
    Current affiliations: Division of Gastroenterology and Hepatology (A.R., A.B., S.W., P.S.), University of Kansas School of Medicine and Veteran's Affairs Medical Center, Department of Internal Medicine (S.P.), University of Kansas School of Medicine, Kansas City, Kansas, Sections of Gastroenterology and Health Services Research (H.B.E.-S.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Published:November 29, 2007DOI:https://doi.org/10.1016/j.gie.2007.07.019

      Background

      Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) are at a high risk for developing esophageal adenocarcinoma. However, the reported rate of cancer development in patients with HGD who were undergoing surveillance has varied among published studies.

      Objective

      To determine an overall precise estimate of cancer incidence in patients with HGD who were undergoing surveillance endoscopy.

      Design

      Systematic review and meta-analysis.

      Methods

      We conducted a systematic search of the published literature and selected original articles that examined patients with histologically proven BE and HGD, patients who had not undergone endoscopic ablation or surgical therapy, patients with 6 months' follow-up, no esophageal cancer at the time of enrollment or within 6 months, and studies in which follow-up was reported in person-time. Two investigators independently conducted the search and abstraction.

      Main Outcome Measurement

      The weighted mean event rate was calculated and expressed as the weighted incidence rate, and its CIs were calculated.

      Results

      The search yielded 4 articles that met the inclusion criteria, and these were analyzed. A total of 236 patients with HGD were followed for 1241 patient-years, and esophageal adenocarcinoma was reported in 69 patients, providing a crude incidence rate of 5.57 per 100 patient-years. The weighted incidence rate was 6.58 per 100 patient-years (95% CI, 4.97-8.19).

      Limitations

      A small number of studies that met inclusion criteria.

      Conclusions

      In patients with BE and with HGD who were undergoing surveillance, esophageal adenocarcinoma develops in approximately 6 per 100 patient-years during the first few years of follow-up. These data may better inform physicians and patients in management decisions.

      Abbreviations:

      BE (Barrett's esophagus), HGD (high-grade dysplasia), SD (standard deviation)
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