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. 2016 Dec 28;22(48):10592-10600.
doi: 10.3748/wjg.v22.i48.10592.

Risk stratification for malignant progression in Barrett's esophagus: Gender, age, duration and year of surveillance

Piers Gatenby  1 , Santanu Bhattacharjee  1 , Christine Wall  1 , Christine Caygill  1 , Anthony Watson  1
Affiliations

Risk stratification for malignant progression in Barrett's esophagus: Gender, age, duration and year of surveillance

Piers Gatenby et al. World J Gastroenterol. .

Abstract

Aim: To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.

Methods: Patients registered with the United Kingdom Barrett's Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.

Results: One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.

Conclusion: The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

Keywords: Barrett’s esophagus; Dysplasia; Epidemiology; Esophageal neoplasms; Public health; Surveillance.

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Conflict of interest statement

Conflict-of-interest statement: None declared, the authors confirm that we have no financial arrangements related to the research or manuscript preparation to disclose.

Figures

Figure 1
Figure 1
Annual incidence of adenocarcinoma and dysplasia dependent on calendar year of surveillance.
Figure 2
Figure 2
Annual incidence of adenocarcinoma and dysplasia dependent on calendar year of surveillance and gender.
Figure 3
Figure 3
Annual incidence of adenocarcinoma and dysplasia dependent on age at surveillance.
Figure 4
Figure 4
Annual incidence of adenocarcinoma and dysplasia dependent on age at surveillance and gender.
Figure 5
Figure 5
Annual incidence of adenocarcinoma and dysplasia dependent on duration of surveillance.
Figure 6
Figure 6
Annual incidence of adenocarcinoma and dysplasia dependent on duration of surveillance and gender.
See this image and copyright information in PMC

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