3517 THE DEVELOPMENT OF DYSPLASIA ON FOLLOW-UP ENDOSCOPY AMONG PATIENTS WITH SHORT SEGMENT BARRETT'S ESOPHAGUS: A COHORT OF 61 PATIENTS FOLLOWED FOR A MEAN OF 30 MONTHS.

Abstract

Background: The incidence of the progression from short segment Barrett's esophagus (SSBE) to dysplasia has not been well established. Knowledge of accurate estimates of this incidence would influence future recommendations for endoscopic surveillance in patients with SSBE. Aim: The aim of this study was to determine the incidence of progression of SSBE to dysplasia in a cohort of patients who had serial endoscopies and biopsies of the gastroesophageal (GE) junction and the distal esophagus. Methods: We reviewed endoscopy and pathology reports of 494 patients who had undergone upper endoscopy with biopsies of the GE junction and the distal esophagus at the Beth Israel Deaconess Medical Center between January 1993 and September 1998 by one of three gastroenterologists with expertise in the diagnosis and management of Barrett's esophagus. Patients identified as having SSBE, defined as displacement of the squamocolumnar junction from the lower esophageal sphincter by less than 3 cm and intestinal metaplasia on pathology, were eligible for the study. Ninety-nine patients (M 54: F 45; mean age 62±13 years) were identified as having SSBE. Of these, 11 patients had dysplasia on the initial endoscopy and were excluded. Sixty-one patients with SSBE (M 37: F 24; mean age 59.5 ±13.3 years) returned for follow-up at least 12 months after the initial endoscopy and were included in the study. The mean number of endoscopies per patient was 3±1 (range, 2-6), and the average time of follow-up was 30±12.5 months (range, 12-71 months). Results: At the initial endoscopy, 4 patients (4%) had low grade dysplasia, 2 patients (2%) had high grade dysplasia, 3 patients (3%) had indefinite dysplasia, and 2 patients (2%) had adenocarcinoma. At the follow-up endoscopy of 61 patients, 19 patients (31%) no longer had intestinal metaplasia identified on biopsies of the GE junction and the distal esophagus. One patient (1.6%) developed low grade dysplasia on the second follow-up endoscopy that was performed 27 months after the initial endoscopy. No patients developed high grade dysplasia or adenocarcinoma. Discussion: Surveillance endoscopy for patients with SSBE results in a low yield of dysplasia. Further long-term study is needed to determine the cost/benefit ratio of surveillance endoscopy in patients with SSBE. Background: The incidence of the progression from short segment Barrett's esophagus (SSBE) to dysplasia has not been well established. Knowledge of accurate estimates of this incidence would influence future recommendations for endoscopic surveillance in patients with SSBE. Aim: The aim of this study was to determine the incidence of progression of SSBE to dysplasia in a cohort of patients who had serial endoscopies and biopsies of the gastroesophageal (GE) junction and the distal esophagus. Methods: We reviewed endoscopy and pathology reports of 494 patients who had undergone upper endoscopy with biopsies of the GE junction and the distal esophagus at the Beth Israel Deaconess Medical Center between January 1993 and September 1998 by one of three gastroenterologists with expertise in the diagnosis and management of Barrett's esophagus. Patients identified as having SSBE, defined as displacement of the squamocolumnar junction from the lower esophageal sphincter by less than 3 cm and intestinal metaplasia on pathology, were eligible for the study. Ninety-nine patients (M 54: F 45; mean age 62±13 years) were identified as having SSBE. Of these, 11 patients had dysplasia on the initial endoscopy and were excluded. Sixty-one patients with SSBE (M 37: F 24; mean age 59.5 ±13.3 years) returned for follow-up at least 12 months after the initial endoscopy and were included in the study. The mean number of endoscopies per patient was 3±1 (range, 2-6), and the average time of follow-up was 30±12.5 months (range, 12-71 months). Results: At the initial endoscopy, 4 patients (4%) had low grade dysplasia, 2 patients (2%) had high grade dysplasia, 3 patients (3%) had indefinite dysplasia, and 2 patients (2%) had adenocarcinoma. At the follow-up endoscopy of 61 patients, 19 patients (31%) no longer had intestinal metaplasia identified on biopsies of the GE junction and the distal esophagus. One patient (1.6%) developed low grade dysplasia on the second follow-up endoscopy that was performed 27 months after the initial endoscopy. No patients developed high grade dysplasia or adenocarcinoma. Discussion: Surveillance endoscopy for patients with SSBE results in a low yield of dysplasia. Further long-term study is needed to determine the cost/benefit ratio of surveillance endoscopy in patients with SSBE.