Dr Stefan Oberg and colleagues evaluated the risk factors for dysplasia and adenocarcinoma development in nondysplastic Barrett mucosa.
The risk for patients with Barrett esophagus to develop esophageal adenocarcinoma is low.
|31% developed low-grade dysplasia and 5% developed adenocarcinoma|
|Annals of Surgery|
The research team report that most patients undergoing surveillance will not develop malignancy.
However, identification of risk factors may allow for more rational surveillance programs.
Within these surveillance programs, the team proposes that patients are stratified according to their risk of progressing to dysplasia and invasive adenocarcinoma.
The researchers studied the development of dysplasia and esophageal adenocarcinoma during long-term endoscopic and histologic surveillance.
The research team included 140 patients with Barrett esophagus free from dysplasia.
The team also evaluated risk factors for progression to dysplasia and adenocarcinoma over a median follow-up of 6 years.
The researchers found that 31% of patients developed low-grade dysplasia and 5% developed high-grade dysplasia or esophageal adenocarcinoma.
Dysplasia development was significantly less common after antireflux surgery compared with conventional medical therapy.
The team noted that low-grade dysplasia was independently associated with an increased risk of developing high-grade dysplasia or esophageal adenocarcinoma.
The same association for an increased risk was shown with long duration of reflux symptoms.
Dr Oberg concludes, “Successful antireflux surgery protects the Barrett mucosa from developing high-grade dysplasia and esophageal adenocarcinoma.”
“This protection occurs possibly by better control of reflux of gastric contents.”
“Low-grade dysplasia is the only clinically useful risk factor that permits stratification of the surveillance intervals according to the risk of the individual patient.”