Mo1247 RISK OF NEOPLASTIC PROGRESSION IN PATIENTS WITH LONG-SEGMENT BARRETT'S ESOPHAGUS-JAPAN MULTICENTER PROSPECTIVE COHORT STUDY

Abstract

The incidence of esophageal adenocarcinoma (EAC) in patients with long-segment Barrett’s esophagus (LSBE) in Japan remains to be fully elucidated. To address this issue, a nationwide multicenter prospective cohort study was designed to investigate EAC incidence rate in patients with BE with a length of at least 3 cm and started in 2011. We previously reported interim analysis findings of follow-up results obtained during the first 4-year period (June 2011 through August 2015), which indicated that the annual incidence rate of EAC in LSBE cases in Japan was 1.2% (Matsuhashi N, et al., J Gastroenterol Hepatol 32: 409-414, 2017). Here, we report findings from the second interim analysis of follow-up results obtained from June 2011 through August 2019. This is an ongoing multicenter prospective cohort study led by the National LSBE Research Group of the Japan Gastroenterological Endoscopy Society involving 13 university medical center and 22 regional hospitals throughout Japan. Based on the Prague criteria, the circumferential (C) and maximum (M) length of BE was noted, then affected patients with a length of 3 cm or longer (M ≥3 cm) were prospectively enrolled. Enrolled BE cases are scheduled for annual esophagogastroduodenoscopy (EGD) examinations for progression to dysplasia or EAC over a 10-year period. Patients with EAC diagnosed from endoscopic examination results undergo subsequent treatment, with their prognosis noted. The registry currently includes 337 participants (males 82.8%; mean age 63.4±12.8 years, range 30-103 years), with a mean follow-up period of 45.3 months (1-8 years). Of those, 12 (3.6%) were initially diagnosed with EAC at enrollment and two-thirds (8/12) were found to be in an advanced clinical stage. Among the remaining 325 with nondysplastic BE, 230 underwent at least 1 follow-up EGD examination, which revealed development of EAC in 6 over a total of 869 patient-years for an annual incidence rate of 0.69%. Five of 6 patients with EAC were male, and the follow-up period until EAC detection varied from 2.6 to 7.0 years. Subgroup analysis found 133 with a long circumferential (C ≥3 cm) BE length and 97 with a short (C <3 cm) BE length, with annual EAC incidence rates of 0.81% and 0.53%, respectively. Most of the EAC cases detected in follow-up annual EGD examinations (5/6, 83.3%) were identified as early stage cancer and those patients underwent curative resection. During follow-up periods ranging from 1-8 years (mean 45.1 months), the annual incidence rate of novel EAC in patients with BE with a length of 3 cm or longer according to the Prague M criteria was estimated to be 0.69%, similar to values reported in Western countries. Most of the EAC cases detected during the follow-up period were early cancer, suggesting the importance of annual surveillance endoscopy.