Introduction
Data on time trends of dysplasia and esophageal adenocarcinoma (EAC) in Barrett’s
esophagus (BE) during the index endoscopy (ie, prevalent cases) are limited. Our aim
was to determine the prevalence patterns of BE-associated dysplasia on index endoscopy
over the past 25 years.
Methods
The Barrett’s Esophagus Study is a multicenter outcome project of a large cohort of
patients with BE. Proportions of patients with index endoscopy findings of no dysplasia
(NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and EAC were extracted
per year of index endoscopy, and 5-yearly patient cohorts were tabulated over years
1990 to 2010+ (2010-current). Prevalent dysplasia and endoscopic findings were trended
over the past 25 years using percentage dysplasia (LGD, HGD, EAC, and HGD/EAC) to
assess changes in detection of BE-associated dysplasia over the last 25 years. Statistical
analysis was done using SAS version 9.4 software (SAS, Cary, NC).
Results
A total of 3643 patients were included in the analysis with index endoscopy showing
NDBE in 2513 (70.1%), LGD in 412 (11.5%), HGD in 193 (5.4%), and EAC in 181 (5.1%).
Over time, there was an increase in the mean age of patients with BE (51.7 ± 29 years
vs 62.6 ± 11.3 years) and the proportion of males (84% vs 92.6%) diagnosed with BE
but a decrease in the mean BE length (4.4±4.3 cm vs 2.9±3.0 cm) as time progressed
(1990-1994 to 2010-2016 time periods). The presence of LGD on index endoscopy remained
stable over 1990 to 2016. However, a significant increase (148% in HGD and 112% in
EAC) in the diagnosis of HGD, EAC, and HGD/EAC was noted on index endoscopy over the
last 25 years (P < .001). There was also a significant increase in the detection of visible lesions
on index endoscopy (1990-1994, 5.1%; to 2005-2009, 6.3%; and 2010+, 16.3%) during
the same period.
Conclusion
Our results suggest that the prevalence of HGD and EAC has significantly increased
over the past 25 years despite a decrease in BE length during the same period. This
increase parallels an increase in the detection of visible lesions, suggesting that
a careful examination at the index examination is crucial.
Abbreviations:
BE (Barrett’s esophagus), CI (confidence interval), EAC (esophageal adenocarcinoma), HGD (high-grade dysplasia), LGD (low-grade dysplasia), NDBE (non-dysplastic Barrett’s esophagus), OR (odds ratio)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 17, 2018
Accepted:
September 24,
2018
Received:
June 9,
2018
Footnotes
DISCLOSURE: Dr Falk is a consultant for CDX and receives funding from Interscope. All other authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
