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Identifying patients at lower risk for esophageal adenocarcinoma

Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for esophageal adenocarcinoma, reports this month's issue of Gastroenterology.

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Recent population-based studies have shown a low risk of esophageal adenocarcinoma in patients with nondysplastic Barrett’s esophagus.

Dr Srinivas Gaddam from Missouri, USA evaluated whether persistence of nondysplastic Barrett’s esophagus over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett’s esophagus.

The team performed a multicenter outcomes study of a large cohort of patients with Barrett’s esophagus.

Based on the number of consecutive surveillance endoscopies showing nondysplastic Barrett’s esophagus, the team identified 5 groups of patients.

Patients in group 1 were found to have nondysplastic Barrett’s esophagus at their first esophagogastroduodenoscopy.

The median follow-up period was 5 years
Gastroenterology

Patients in group 2 were found to have nondysplastic Barrett’s esophagus on their first 2 consecutive esophagogastroduodenoscopies.

Similarly, patients in groups 3, 4, and 5 were found to have nondysplastic Barrett’s esophagus on 3, 4, and 5 consecutive surveillances for esophageal adenocarcinoma.

A logistic regression model was built to determine whether persistence of nondysplastic Barrett’s esophagus independently protected against development of cancer.

Of a total of 3515 patients with Barrett’s esophagus, 1401 patients met the inclusion criteria.

The median follow-up period was 5 years.

The team noted that the annual risk of esophageal adenocarcinoma in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively.

After adjusting for age, sex, and length of Barrett’s esophagus, persistence of nondysplastic Barrett’s esophagus, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to esophageal adenocarcinoma.

Dr Gaddam's team concludes, "Persistence of nondysplastic Barrett’s esophagus over several endoscopic examinations identifies patients who are at low risk for development of esophageal adenocarcinoma."

"These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent nondysplastic Barrett’s esophagus."

Gastroenterol 2013: 145(3) 548-553
09 September 2013

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