Outcomes of patients with Barrett's oesophagus with low‐grade dysplasia undergoing endoscopic surveillance in a tertiary centre: a retrospective cohort study

• Published in: Internal medicine journal 2024-11, Vol.54 (11), p.1867-1875
• Main Authors: Vlismas, Luke J., Potter, Michael, Loewenthal, Mark R., Wilson, Katie, Allport, Kelleigh, Gillies, Donna, Cook, Dane, Philcox, Stephen, Bollipo, Steven, Talley, Nicholas J.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnosis; Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Australia - epidemiology; Barrett Esophagus - diagnosis; Barrett Esophagus - epidemiology; Barrett Esophagus - pathology; Barrett's esophagus; Barrett's oesophagus; Cohort Studies; Disease Progression; Dysplasia; Endoscopy; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - pathology; Esophagoscopy; Female; Follow-Up Studies; Humans; low‐grade dysplasia; Male; Malignancy; Medical records; metaplasia; Middle Aged; neoplasia; oesophageal neoplasm; Patients; Population Surveillance - methods; Precancerous Conditions - epidemiology; Precancerous Conditions - pathology; Retrospective Studies; Risk Factors; Surveillance; Survival analysis; Tertiary Care Centers; upper gastrointestinal endoscopy
• ISSN: 1444-0903; 1445-5994; 1445-5994
• DOI: 10.1111/imj.16532

Background and Aim Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low‐grade dysplasia (LGD) or high‐grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6‐monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression. Methods Endoscopy and pathology databases were searched over a 10‐year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow‐up times varied greatly, survival analysis techniques were employed. Results Fifty‐nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non‐guideline‐adherent surveillance. A Cox model found only two predictors of progression: (i) guideline‐adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non‐guideline‐adherent surveillance (95% confidence interval (CI) = 1.3–12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9–22.8; P = 0.003). Conclusion Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline‐recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.