Increasing prevalence of high-grade dysplasia and adenocarcinoma on index endoscopy in Barrett’s esophagus over the past 2 decades: data from a multicenter U.S. consortium

Published:October 17, 2018DOI:


      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.


      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).


      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.


      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.


      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pohl H.
        • Welch H.G.
        The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.
        J Natl Cancer Inst. 2005; 97: 142-146
        • Schneider J.L.
        • Corley D.A.
        The troublesome epidemiology of Barrett's esophagus and esophageal adenocarcinoma.
        Gastrointest Endosc Clin N Am. 2017; 27: 353-364
        • Blot W.J.
        • McLaughlin J.K.
        The changing epidemiology of esophageal cancer.
        Semin Oncol. 1999; 26: 2-8
        • Botterweck A.A.
        • Schouten L.J.
        • Volovics A.
        • et al.
        Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries.
        Int J Epidemiol. 2000; 29: 645-654
        • Vizcaino A.P.
        • Moreno V.
        • Lambert R.
        • et al.
        Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973-1995.
        Int J Cancer. 2002; 99: 860-868
        • Lord R.V.
        • Law M.G.
        • Ward R.L.
        • et al.
        Rising incidence of oesophageal adenocarcinoma in men in Australia.
        J Gastroenterol Hepatol. 1998; 13: 356-362
      1. Howlader N, Noone AM, Krapcho M, editors. SEER Cancer Statistics Review, 1975-2014. Bethesda, MD: National Cancer Institute. Available at:, based on November 2016 SEER data submission, posted to the SEER web site. Accessed April 2017.

        • Hvid-Jensen F.
        • Pedersen L.
        • Drewes A.M.
        • et al.
        Incidence of adenocarcinoma among patients with Barrett's esophagus.
        N Engl J Med. 2011; 365: 1375-1383
        • Bhat S.
        • Coleman H.G.
        • Yousef F.
        • et al.
        Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study.
        J Natl Cancer Inst. 2011; 103: 1049-1057
        • Spechler S.J.
        • Sharma P.
        • et al.
        • American Gastroenterological Association
        American Gastroenterological Association medical position statement on the management of Barrett's esophagus.
        Gastroenterology. 2011; 140: 1084-1091
        • Shaheen N.J.
        • Falk G.W.
        • Iyer P.G.
        • et al.
        ACG clinical guideline: diagnosis and management of Barrett's esophagus.
        Am J Gastroenterol. 2016; 111 (quiz 1): 30-50
        • Visrodia K.
        • Singh S.
        • Krishnamoorthi R.
        • et al.
        Magnitude of missed esophageal adenocarcinoma after Barrett's esophagus diagnosis: a systematic review and meta-analysis.
        Gastroenterology. 2016; 150 (quiz e14-15): 599-607 e7
        • Gupta N.
        • Gaddam S.
        • Wani S.B.
        • et al.
        Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett's esophagus.
        Gastrointest Endosc. 2012; 76: 531-538
        • Conio M.
        • Cameron A.J.
        • Romero Y.
        • et al.
        Secular trends in the epidemiology and outcome of Barrett's oesophagus in Olmsted County, Minnesota.
        Gut. 2001; 48: 304-309
        • van Soest E.M.
        • Dieleman J.P.
        • Siersema P.D.
        • et al.
        Increasing incidence of Barrett's oesophagus in the general population.
        Gut. 2005; 54: 1062-1066
        • Prach A.T.
        • MacDonald T.A.
        • Hopwood D.A.
        • et al.
        Increasing incidence of Barrett's oesophagus: education, enthusiasm, or epidemiology?.
        Lancet. 1997; 350: 933
        • Macdonald C.E.
        • Wicks A.C.
        • Playford R.J.
        Ten years' experience of screening patients with Barrett's oesophagus in a university teaching hospital.
        Gut. 1997; 41: 303-307
        • Spechler S.J.
        • Sharma P.
        • Souza R.F.
        • et al.
        American Gastroenterological Association technical review on the management of Barrett's esophagus.
        Gastroenterology. 2011; 140 (quiz e13): e18-e52
        • Thota P.N.
        • Vennalaganti P.
        • Vennelaganti S.
        • et al.
        Low risk of high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett's esophagus less than 1 cm (irregular Z line) within 5 years of index endoscopy.
        Gastroenterology. 2017; 152: 987-992
        • Evans J.A.
        • Early D.S.
        • Fukami N.
        • et al.
        • ASGE Standards of Practice Committee
        The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus.
        Gastrointest Endosc. 2012; 76: 1087-1094
        • Bosetti C.
        • Levi F.
        • Ferlay J.
        • et al.
        Trends in oesophageal cancer incidence and mortality in Europe.
        Int J Cancer. 2008; 122: 1118-1129
        • Cook M.B.
        • Chow W.H.
        • Devesa S.S.
        Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977-2005.
        Br J Cancer. 2009; 101: 855-859
        • Jemal A.
        • Bray F.
        • Center M.M.
        • et al.
        Global cancer statistics.
        CA Cancer J Clin. 2011; 61: 69-90
        • Kong C.Y.
        • Kroep S.
        • Curtius K.
        • et al.
        Exploring the recent trend in esophageal adenocarcinoma incidence and mortality using comparative simulation modeling.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 997-1006
        • Lepage C.
        • Rachet B.
        • Jooste V.
        • et al.
        Continuing rapid increase in esophageal adenocarcinoma in England and Wales.
        Am J Gastroenterol. 2008; 103: 2694-2699
        • Coleman H.G.
        • Bhat S.
        • Murray L.J.
        • et al.
        Increasing incidence of Barrett's oesophagus: a population-based study.
        Eur J Epidemiol. 2011; 26: 739-745
        • Devesa S.S.
        • Blot W.J.
        • Fraumeni Jr., J.F.
        Changing patterns in the incidence of esophageal and gastric carcinoma in the United States.
        Cancer. 1998; 83: 2049-2053
        • Kendall B.J.
        • Whiteman D.C.
        Temporal changes in the endoscopic frequency of new cases of Barrett's esophagus in an Australian health region.
        Am J Gastroenterol. 2006; 101: 1178-1182
        • Thrift A.P.
        • Whiteman D.C.
        The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends.
        Ann Oncol. 2012; 23: 3155-3162
        • El-Serag H.B.
        • Aguirre T.
        • Kuebeler M.
        • et al.
        The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy.
        Aliment Pharmacol Ther. 2004; 19: 1255-1260
        • El-Serag H.B.
        • Garewel H.
        • Kuebeler M.
        • et al.
        Is the length of newly diagnosed Barrett's esophagus decreasing? The experience of a VA Health Care System.
        Clin Gastroenterol Hepatol. 2004; 2: 296-300
        • Nguyen T.
        • Alsarraj A.
        • El-Serag H.B.
        Brief report: the length of newly diagnosed Barrett's esophagus may be decreasing.
        Dis Esophagus. 2015; 28: 418-421