2861 Importance of Barrett's Surveillance in the Senior Population

Abstract

INTRODUCTION: It is estimated that 5.6% of adults in the United States have Barrett’s esophagus (1). The annual cancer incidence in patients with Barrett’s esophagus is 0.1-0.4% per year, with it being higher among men, older patients, and patients with long segment Barrett’s mucosa. In patients with Barrett’s esophagus with low grade dysplasia (LGD), the annual incidence rates of esophageal adenocarcinoma (EAC) is 0.54% and of high-grade dysplasia (HGD) and/or EAC is 1.73%. Although the benefit of surveillance endoscopy remains unclear, current guidelines recommend surveillance endoscopy to detect dysplasia or EAC early enough to provide effective treatment. Currently there is no consensus on the age limit for Barrett’s surveillance, nor is there a recommended duration of surveillance. This may lead to endoscopic surveillance being performed without clear benefit. (2,3) Our aim was to assess the role of Barrett’s surveillance in detecting dysplasia and malignancy in all age groups; and evaluate the incidence and progression of Barrett's dysplasia to determine an age or duration limit to endoscopic surveillance. METHODS: A retrospective single center, longitudinal study was done by Sierra Nevada Gastroenterology Medical Associates, Inc., a community based gastroenterology group in Grass Valley, California. All outpatient upper endoscopies for Barrett’s screening and surveillance were included in the study. 300 electronic medical records were randomly selected and reviewed from Jan 2005 to Oct 2018. Data was collected on age, gender, race, ASA class, procedure findings, complications, pathology, and dysplasia status. RESULTS: See attached tables. CONCLUSION: In this study LGD was found in 10%, HGD in 0.3% and EAC in 0.3% of patients. In the subgroup of patients with LGD: 27% were detected in patients over 80 years old, 87% detected in patients with short Barrett's, 97% regressed to no dysplasia, and 3% progressed to HGD requiring ablation therapy. 16% of patients over 80 years old maintained or had dysplasia progress. Overall, 1 patient presented with EAC at index endoscopy. 91% of our study population had short Barrett's. There was no dysplasia before age 50 and dysplasia incidence increased with age. There were no endoscopy related complications. In patients over 80 years old, the incidence and progression of dysplasia remains significant. When evaluating endoscopy in this population, risks and benefits need to be considered, but age alone should not exclude a patient from surveillance.