Original article
Alimentary tract
Association Between Length of Barrett's Esophagus and Risk of High-grade Dysplasia or Adenocarcinoma in Patients Without Dysplasia

https://doi.org/10.1016/j.cgh.2013.05.007Get rights and content

Background & Aims

It is not clear whether length of Barrett's esophagus (BE) is a risk factor for high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with nondysplastic BE. We studied the risk of progression to HGD or EAC in patients with nondysplastic BE, based on segment length.

Methods

We analyzed data from a large cohort of patients participating in the BE Study—a multicenter outcomes project comprising 5 US tertiary care referral centers. Histologic changes were graded as low-grade dysplasia, HGD, or EAC. The study included patients with BE of documented length without dysplasia and at least 1 year of follow-up evaluation (n = 1175; 88% male), and excluded patients who developed HGD or EAC within 1 year of their BE diagnosis. The mean follow-up period was 5.5 y (6463 patient-years). The annual risk of HGD and EAC was plotted in 3-cm increments (≤3 cm, 4–6 cm, 7–9 cm, 10–12 cm, and ≥13 cm). We calculated the association between time to progression and length of BE.

Results

The mean BE length was 3.6 cm; 44 patients developed HGD or EAC, with an annual incidence rate of 0.67%/y. Compared with nonprogressors, patients who developed HGD or EAC had longer BE segments (6.1 vs 3.5 cm; P < .001). Logistic regression analysis showed a 28% increase in risk of HGD or EAC for every 1-cm increase in BE length (P = .01). Patients with BE segment lengths of 3 cm or shorter took longer to develop HGD or EAC than those with lengths longer than 4 cm (6 vs 4 y; P = nonsignificant).

Conclusions

In patients with BE without dysplasia, length of BE was associated with progression to HGD or EAC. The results support the development of a risk stratification scheme for these patients based on length of BE segment.

Section snippets

Patients

The BE Study (BEST) is a multicenter outcomes project that includes 5 tertiary care referral centers with an interest in BE. These include the Veterans Affairs Medical Center (Kansas City, MO), the Southern Arizona Veterans Affairs Health Care System (Tucson, AZ), the Cleveland Clinic (Cleveland, OH), the Veterans Affairs Medical Center (Portland, OR), and the Bethesda Naval Medical Center (Bethesda, MD). The study was approved by the institutional review board at each institution.

Patients

Results

Of the total number of 3515 patients in the database, 1175 patients met the inclusion criteria. The flow of patients in this study and reasons for exclusion are highlighted in Figure 1.

The mean age of this cohort was 59.2 years (standard deviation standard deviation [SD], 11.7 y). The vast majority were Caucasians (93.1%) and males (88%). The mean follow-up period was 5.5 years (SD, 3.94 y), with a total of 6463 patient-years of follow-up evaluation. The mean BE length was 3.6 cm (SD, 3.1 cm).

Discussion

The results of this large multicenter cohort of 1175 patients with NDBE with a mean follow-up period of 5.5 years (6426 patient-years) show that the annual risk of HGD/EAC increases with an increase in the length of the Barrett's segment. The annual risk for the combined end point of HGD/EAC was 0.31%/y for Barrett's length of 3 cm or less, but increased to 2.41%/y for Barrett's length of 13 cm or longer. Our study highlights the increase in the risk of developing of HGD/EAC with increasing

Conclusions

The results from this large multicenter cohort show that BE length is a significant predictor of progression to HGD/EAC. These results provide support for the development of a risk-stratification scheme for NDBE patients using the length of the BE segment. Surveillance intervals for patients with shorter segments could be extended beyond the conventional 3 to 5 years.

Acknowledgments

Presented in part at the Barrett's Esophagus Research Forum at Digestive Diseases Week, May 7–10, 2011, Chicago, IL.

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    Conflicts of interest The authors disclose no conflicts.

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