3526 BARRETT'S ESOPHAGUS. SURVEILLANCE FOR SHORT AND LONG SEGMENT DISEASE.

Abstract

Background: Long segment Barrett's Esophagus (LSBE) is a precursor of adenocarcinoma of the esophagus and surveillance is part of accepted management. Short segment Barrett's Esophagus (SSBE) is diagnosed with uncertain frequency and carries an unclear cancer risk. Methods: 152 patients with Barrett's esophagus (BE) were identified via billing and medical records of a large GI practice for the period 1/98-11/99. The diagnosis of BE required a verbal description of abnormal mucosa above the EG junction plus a pathologic diagnosis of specialized columnar epithelium or goblet cells. 50 patients were found to have SSBE with less than 3 cm of abnormal mucosa. There were 7 patients with low grade dysplasia (LGD) or indefinite dysplasia (ID) on biopsy. No patient with SSBE had high grade dysplasia (HGD) or cancer. There were 16 separate endoscopies(EGD's) with some dysplasia(10% of 159 SSBE EGD's) or 13% risk of dysplasia/year of surveillance. 102 patients had LSBE. 34 patients had 85 EGD's with some dysplasia noted (20% of 423 EGD's) or 18%risk of dysplasia/year of surveillance. 8 EGD's revealed HGD. Three esophageal cancers were identified (2 on initial EGD) and 2 other patients had surgery for HGD. Total years of surveillance were 478 for LSBE and 123 for SSBE. Average surveillance interval was 15.7 months for both groups. We conclude that SSBE is commonly diagnosed and constitutes 1/3 of our BE patients. The cancer risk in both SSBE and LSBE appears to be well under 1 per 100 years of surveillance. The dysplasia risk per year of surveillance was higher than expected for SSBE and suggests that SSBE is not a benign condition. We intend to follow these patients longitudinally, but increase the surveillance interval, especially in those without dysplasia. Dysplasia SSBE (n=50) LSBE (n=102) LGD 4 25 Indefinite Dysplasia 4 14 HGD 0 8 Adenocarcinoma 0 3 total EGD's with dysplasia 16/159 85/423 Background: Long segment Barrett's Esophagus (LSBE) is a precursor of adenocarcinoma of the esophagus and surveillance is part of accepted management. Short segment Barrett's Esophagus (SSBE) is diagnosed with uncertain frequency and carries an unclear cancer risk. Methods: 152 patients with Barrett's esophagus (BE) were identified via billing and medical records of a large GI practice for the period 1/98-11/99. The diagnosis of BE required a verbal description of abnormal mucosa above the EG junction plus a pathologic diagnosis of specialized columnar epithelium or goblet cells. 50 patients were found to have SSBE with less than 3 cm of abnormal mucosa. There were 7 patients with low grade dysplasia (LGD) or indefinite dysplasia (ID) on biopsy. No patient with SSBE had high grade dysplasia (HGD) or cancer. There were 16 separate endoscopies(EGD's) with some dysplasia(10% of 159 SSBE EGD's) or 13% risk of dysplasia/year of surveillance. 102 patients had LSBE. 34 patients had 85 EGD's with some dysplasia noted (20% of 423 EGD's) or 18%risk of dysplasia/year of surveillance. 8 EGD's revealed HGD. Three esophageal cancers were identified (2 on initial EGD) and 2 other patients had surgery for HGD. Total years of surveillance were 478 for LSBE and 123 for SSBE. Average surveillance interval was 15.7 months for both groups. We conclude that SSBE is commonly diagnosed and constitutes 1/3 of our BE patients. The cancer risk in both SSBE and LSBE appears to be well under 1 per 100 years of surveillance. The dysplasia risk per year of surveillance was higher than expected for SSBE and suggests that SSBE is not a benign condition. We intend to follow these patients longitudinally, but increase the surveillance interval, especially in those without dysplasia. Dysplasia SSBE (n=50) LSBE (n=102) LGD 4 25 Indefinite Dysplasia 4 14 HGD 0 8 Adenocarcinoma 0 3 total EGD's with dysplasia 16/159 85/423