TY - JOUR
T1 - Lower Annual Rate of Progression of Short-Segment vs Long-Segment Barrett's Esophagus to Esophageal Adenocarcinoma
AU - Hamade, Nour
AU - Vennelaganti, Sreekar
AU - Parasa, Sravanthi
AU - Vennalaganti, Prashanth
AU - Gaddam, Srinivas
AU - Spaander, Manon C.W.
AU - van Olphen, Sophie H.
AU - Thota, Prashanthi N.
AU - Kennedy, Kevin F.
AU - Bruno, Marco J.
AU - Vargo, John J.
AU - Mathur, Sharad
AU - Cash, Brooks D.
AU - Sampliner, Richard
AU - Gupta, Neil
AU - Falk, Gary W.
AU - Bansal, Ajay
AU - Young, Patrick E.
AU - Lieberman, David A.
AU - Sharma, Prateek
N1 - Publisher Copyright:
© 2019 AGA Institute
PY - 2019/4
Y1 - 2019/4
N2 - Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
AB - Background & Aims: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). Methods: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. Results: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P =.001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P <.001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18–0.57; P <.001). Conclusion: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
KW - Esophageal Cancer
KW - Long-Term Follow-Up
KW - Outcome
KW - Risk Factor
UR - http://www.scopus.com/inward/record.url?scp=85059324365&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2018.07.008
DO - 10.1016/j.cgh.2018.07.008
M3 - Article
C2 - 30012433
AN - SCOPUS:85059324365
SN - 1542-3565
VL - 17
SP - 864
EP - 868
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 5
ER -