Abstract
Introduction: The risk for esophageal adenocarcinoma (EAC) increases as nondysplastic Barrett's esophagus (NDBE) progresses to Barrett's esophagus (BE) with low grade dysplasia (LGD) and high grade dysplasia (HGD). Several factors, including characteristic of the BE segment, may increase the risk for progression to EAC. The purpose of this study is to evaluate BE length as an independent risk factor for the development of EAC. Methods: A retrospective cohort study was conducted of patients at a tertiary care center with BE undergoing radiofrequency ablation (RFA) over a 10 year period. The electronic medical record was reviewed to collect the following data: age, sex, age at diagnosis of BE and EAC, pathology, and length of BE segment at initiation of treatment. Results: 301 patients with BE who underwent RFA were assessed. 249 (82.7%) were male. The mean age at BE diagnosis was 62.1 years. The average BE segment length, at initiation of treatment, was 3.52cm (range <1cm to 18cm). 19 patients with intramucosal adenocarcinoma on index endoscopy were excluded. 26 (9.2%) patients progressed to EAC; 5 from NDBE to EAC, 2 from indefinite for dysplasia to EAC, 5 from LGD to EAC, 14 from HGD to EAC. In patients that progressed to EAC, the average BE segment length was 6.08cm (±4.48) compared to 4.72cm (±3.25) in patients that did not develop EAC. In a logistic regression model adjusted for sex and the number of RFA treatments, we found that length of BE segment was a significant independent predictor of progression to adenocarcinoma (OR=1.16, 95%CI: 1.03-1.30). Conclusion: BE is a known risk factor for EAC. BE with LGD and HGD carries a higher risk for EAC than NDBE. Our study suggests that patients with longer segments of BE, regardless of the presence of dysplasia, are at increased risk for progression to EAC. For every 1cm increase in length of BE, the risk for progression to EAC increases by 16%. We suggest that the length of BE along with dysplasia are both important risk factors for EAC and should be carefully surveyed and considered for treatment with RFA.
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