335. LONG TERM RISK FOR PROGRESSION TO NEOPLASIA FOR BARRETT’S ESOPHAGUS PATIENTS WITH VALIDATED LOW-GRADE DYSPLASIA OR INDEFINITE FOR DYSPLASIA

Abstract

Abstract Barrett’s esophagus (BE) with low-grade dysplasia (LGD) confirmed by two pathologists has a high risk of progression to high-grade dysplasia and cancer why ablation or more intense surveillance is recommended. Recent studies suggest that the progression risks for indefinite for dysplasia (IND) and LGD are similar, but the management guidelines are still different. We did a retrospective analysis to calculate the long-term risk for patients with verified LGD and IND. All patients in the Ersta hospital BE-database in Stockholm who at least on one occasion during 1998 to 2012 were diagnosed with dysplasia. The first dysplastic specimen was re-evaluated by two highly experienced GI-pathologist. Clinical data was retrieved from the database and from patient medical records. Incidence rate (IR) was calculated for developing high-grade dysplasia (HGD) or cancer and IR ratio (IRR) was used as relative risk evaluation between the non-dysplastic Barrett’s Esophagus (NDBE) group and the LGD/IND groups and presented with 95% Confidence Intervals (CI). Of 1180 patients with BE, 455 (39%) were diagnosed with dysplasia. 32 were excluded and 3 had HGD. Of the remaining 420 patients, 266 (63%) could be downgraded to NDBE, 82 (20%) were diagnosed as LGD and 71 (17%) as IND. Total follow-up was 4592 person years. The median follow-up time was 12 years. 34 patients developed neoplasia. The yearly IR for HGD or cancer among patients downgraded to NDBE was found to be 0,3% compared to 1,8% for LGD and 1,4% for IND. There was a five-fold increased risk of HGD or cancer among LGD/IND as compared to NDBE. Patients with confirmed IND and LGD were found to have almost similarly elevated long-term risk for progression to neoplasia. Therefore, it seems reasonable that IND patients undergo the same surveillance regimen as non-treated LGD patients. Four patients (one with NDBE, two IND and one LGD) developed cancer more than 20 years after their initial BE diagnosis and therefore, it should be considered to keep BE patients in surveillance programs for a long period of time.