Increasing Prevalence of Barrett's Esophagus with Relatively Low Risk of Neoplasia - Three-Year Prospective Cohort Study from Central European Country

Abstract

Background and Aim: Barrett's esophagus (BE) is a premalignant condition. Due to unclear reasons the prevalence of BE as well as the risk of BE-related neoplasia are higher in US and Western Europe in comparison to less developed countries. The aim of the study was to assess the prevalence of BE and BE-related neoplasia in unselected patients undergoing esophago-gastro-duodenoscopy (EGD) in single endoscopy unit in Poland. Material and Methods: All consecutive EGD reports from January 2005 to December 2007 were analyzed, including demographic data, EGD indications and endoscopic findings. Montreal classification definitions were used. Overall 6414 EGDs were included (54% females; median age 56 years, IQ range 45 to 68). Results: The diagnosis of endoscopically suspected esophageal metaplasia (ESEM) was made in 452 of 6414 EGDs (7.0%). In 5.3% of patients this was a new diagnosis and in remaining 1.7% EGD was done for BE surveillance. There was a significant increase during the study years in relative ESEM frequencies, both overall (5.5%, 6.4%, and 9.7% in 2005, 2006 and 2007, respectively, p<0.0001) and as a new diagnosis (4.2%, 5.2%, 7.0%, respectively, p<0.0001). ESEM was found more frequently when GERD was an indication for EGD (11% vs. 4% for other indications, p<0.0001) in males vs. females (9% vs. 5%, p<0.0001), in patients >36 years vs. younger (8% vs. 5%, p=0.001), and in patients with hiatal hernia (27% vs. 5%, p<0.0001). The median ESEM length was 10 mm (IQ range 7 to 20), and 19% of ESEM segments were long (30 mm or more). Standardized random biopsies were taken from ESEM in 325 cases. The specialized intestinal metaplasia (SIM) was found in 51.5% of ESEM. The frequency of SIM also increased over study years (42%, 44%, and 65% respectively, p=0.001). SIM was more frequent in patients >41 years vs. younger (56% vs. 26%, p=0.0001) and in patients with length of ESEM >20 mm vs. shorter (67% vs. 47%, p=0.005). However, SIM was significantly less frequent in patients in whom GERD was the indication for EGD vs. other indications (34% vs. 50%, p=0.02). The prevalence of intraepithelial neoplasia (IN) - low-grade or high-grade IN and cancer - was low (5.8% of ESEM) with only three cases of HGD (0.9%) and one cancer (0.3%). IN was more frequent in patients >57 years vs. younger (11% vs. 1%; p<0.0001), with previously diagnosed BE (16% vs. 2%; p<0.0001) and in patients with length of ESEM > 45 mm (20% vs. 4%; p=0.008). Conclusions: The frequency of diagnosis of BE shows increasing tendency, but the prevalence of BE-related neoplasia in Central Europe is low. The risk of IN is highest in elderly patients with previously diagnosed long segment BE.