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Multicenter Study
. 2021 Oct;9(8):929-937.
doi: 10.1002/ueg2.12114. Epub 2021 Jul 6.

Barrett's esophagus surveillance in a prospective Dutch multi-center community-based cohort of 985 patients demonstrates low risk of neoplastic progression

Esther Klaver  1 , Angela Bureo Gonzalez  1 , Nahid Mostafavi  1 , Rosalie Mallant-Hent  2 , Lucas C Duits  1 , Bert Baak  3 , Clarisse J M Böhmer  4 , Arnoud H A M van Oijen  5 , Ton Naber  6 , Pieter Scholten  7 , Sybren L Meijer  8 , Jacques J G H M Bergman  1 , Roos E Pouw  1 ; ReBus Study Group
Affiliations
Multicenter Study

Barrett's esophagus surveillance in a prospective Dutch multi-center community-based cohort of 985 patients demonstrates low risk of neoplastic progression

Esther Klaver et al. United European Gastroenterol J. 2021 Oct.

Abstract

Background and aims: Barrett's esophagus (BE) is accompanied by an increased risk of developing esophageal cancer. Accurate risk-stratification is warranted to improve endoscopic surveillance. Most data available on risk factors is derived from tertiary care centers or from cohorts with limited surveillance time or surveillance quality. The aim of this study was to assess endoscopic and clinical risk factors for progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in a large prospective cohort of BE patients from community hospitals supported by an overarching infrastructure to ensure optimal surveillance quality.

Methods: A well-defined prospective multicenter cohort study was initiated in six community hospitals in the Amsterdam region in 2003. BE patients were identified by PALGA search and included in a prospective surveillance program with a single endoscopist performing all endoscopies at each hospital. Planning and data collection was performed by experienced research nurses who attended all endoscopies. Endpoint was progression to HGD/EAC.

Results: Nine hundred eighty-five patients were included for analysis. During median follow-up of 7.9 years (IQR 4.1-12.5) 67 patients were diagnosed with HGD (n = 28) or EAC (n = 39), progression rate 0.78% per patient-year. As a clinical risk factor age at time of endoscopy was associated with neoplastic progression (HR 1.05; 95% CI 1.03-1.08). Maximum Barrett length and low-grade dysplasia (LGD) at baseline were endoscopic predictors of progression (HR 1.15; 95% CI 1.09-1.21 and HR 2.36; 95% CI 1.29-4.33).

Conclusion: Risk of progression to HGD/EAC in a large, prospective, community-based Barrett's cohort was low. Barrett's length, LGD and age were important risk factors for progression. (www.trialregister.nl NTR1789).

Keywords: Barrett; Barrett's esophagus; esophageal adenocarcinoma; esophageal cancer; follow-up; high-grade dysplasia; malignancy; neoplastic progression; risk factors; surveillance.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart
FIGURE 2
FIGURE 2
Bar chart of risk scores and incidence of high‐grade dysplasia/esophageal adenocarcinoma
FIGURE 3
FIGURE 3
Comparing the risk of progression in 7 years in our study with Parasa et al study
See this image and copyright information in PMC

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