External validation of a model determining risk of neoplastic progression of Barrett’s esophagus in a cohort of U.S. veterans

Published:January 05, 2022DOI:

      Background and Aims

      Risk of esophageal adenocarcinoma (EAC) in those with Barrett’s esophagus (BE) is 11-fold greater than the general population. It remains unclear which BE patients are at highest risk of progression to EAC. We aimed to validate a predictive model risk-stratifying BE patients.


      We conducted a retrospective cohort study at the Houston Veteran Affairs Medical Center of consecutive patients with a new diagnosis of BE from November 1990 to January 2019. Study follow-up was through February 2020. Patients were excluded if they had no follow-up EGD with esophageal biopsy sampling after the initial BE-diagnosing EGD or evidence of high-grade dysplasia (HGD) or EAC on initial EGD. We performed an external validation study of a risk model containing sex, smoking, BE length, and low-grade dysplasia (LGD) status and assessed discriminatory ability using the area under the receiver operating characteristic curve (AUROC).


      Among 608 BE patients, 24 progressed to HGD/EAC. The points-based model discriminated well with an AUROC of .72 (95% confidence interval [CI], .63-.82). When categorized into low-, intermediate-, and high-risk groups according to published cutoffs, the AUROC was poor at .57. Restructured into low-risk versus high-risk groups, the AUROC was .72 (95% CI, .64-.80). Excluding baseline LGD did not reduce discriminatory ability (AUROC, .73; 95% CI, .64-.82).


      This external validation provides further evidence that the model including sex, LGD status, smoking status, and BE length may help to risk stratify BE patients. A simplified version excluding LGD status and/or reducing the number of risk groups has increased utility in clinical practice without loss of discriminatory ability.


      AUROC (area under the receiver operating characteristic curve), BE (Barrett’s esophagus), CI (confidence interval), EAC (esophageal adenocarcinoma), HGD (high-grade dysplasia), HR (hazard ratio), LGD (low-grade dysplasia), MEDVAMC (Michael E. DeBakey Veteran Affairs Medical Center), NDBE (nondysplastic Barrett’s esophagus), SD (standard deviation)
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      Linked Article

      • Risk-stratification models for Barrett’s esophagus: Will we get to the perfect classifier?
        Gastrointestinal EndoscopyVol. 95Issue 6
        • Preview
          Barrett’s esophagus (BE) is accompanied by an increased risk for the development of esophageal adenocarcinoma (EAC). Enrolling patients with BE into endoscopic surveillance programs is therefore a common practice with the aim to detect EAC at a curable stage. It also allows precursor lesions such as low-grade dysplasia (LGD) and high-grade dysplasia (HGD) to be found and treated before further disease progression. The effectiveness of current BE surveillance is, however, questionable, inasmuch as the absolute risk of malignant progression of BE is low, early neoplastic lesions are difficult to detect, and current biopsy protocols are subject to sampling error.
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