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Barrett’s with indefinite for dysplasia carries risk for progression
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Patients with Barrett’s Esophagus with indefinite for dysplasia are at similar risk for malignant progression and should be screened like patients with low-grade dysplasia, according to results of a meta-analysis published in Gastrointestinal Endoscopy.
“Currently, there are no reliable estimates for progression risk to [high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC)] in patients with [Barrett’s esophagus with indefinite for dysplasia (BE-IND)],” Prasad G. Iyer, MD, MSc, from the division of gastroenterology and hepatology at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Hence, management strategies for BE-IND are unclear and endoscopy is not routinely recommended.”
Investigators searched the literature for studies that reported incidence of HGD, EAC or HGD/EAC as an outcome in patients with BE-IND who underwent endoscopic surveillance. They estimated the pooled incidence rate of HGD and/or EAC and EAC alone among the patients in the eight studies that met their criteria.
In 1,441 patients over 5,306 person-years, researchers identified 89 cases of HGD and/or EAC (pooled incidence rate = 1.5 per 100 person-years; 95% CI, 1–2). For EAC alone, they identified 40 cases in 1,266 patients over 4,520.2 person-years (pooled incidence rate = 0.6 per 100 person-years; 95% CI, 0.1–1.1).
Additionally, investigators determined that the pooled incidence of low-grade dysplasia was 11.4 per 100 person-years (95% CI, 0.06–0.2).
Iyer and colleagues wrote that their findings show a similar risk for HGD/EAC and EAC among patients with BE-IBD and BE with low-grade dysplasia. They wrote that both groups should undergo similar surveillance intervals.
“Based on the current study’s risk estimates of progression, patients with BE-IND should be placed on active endoscopic surveillance after their anti-reflux regimen is optimized,” they wrote. “Prospective studies to define the natural history of BE-IND are needed to confirm these data.” – by Alex Young
Disclosures : Iyer reports receiving research funding from Exact Sciences, Medtronic, NinePoint Medical and Pentax Medical. He also reports consulting for Medtronic, Pentax and Symple Surgical. Please see the full study for all other authors’ relevant financial disclosures.
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