P189 PREDICTORS OF BARRETT’S OESOPHAGUS PROGRESSION : WHERE ARE WE?

Abstract

Abstract Introduction Barrett’s esophagus (BE) is a well-established precursor lesion for oesophageal adenocarcinoma, which carries an overall poor prognosis (1-2). Patients diagnosed with Barrett’s oesophagus therefore undergo regular endoscopic surveillance to detect neoplastic lesions at an early stage to allow curative treatments (3). The low incidence of esophageal adenocarcinoma (EAC) in Barrett’s oesophagus patients highlights the need for risk stratification tools of patients on surveillance. In this review, we present current potential biomarkers and their associated diagnostic accuracy for the prediction of progression in BE. Materials and methods We searched MEDLINE, EMBASE, Web of Science, CENTRAL and Pubmed publisher. All studies on factors of Be progression were included. Two authors independently assessed the trials and extracted data. Quality assessment of studies was performed using QUADAS scoring. Pooled analysis was performed through Medusa software. Results The inclusion criteria were met by 25 studies. All the studies evaluated diagnostic accuracy of the biomarker to detect progression of Barrett’s to high grade dysplasia (HGD) and EAC. The biomarkers were p53 mutation in 6 studies, Methylation in 4 studies, Clinical factors in 7 studies and genetic factors in 5 studies and other biomarkers in 7 studies. The pooled sensitivity and specificity for BO were 83.4 % [95 % confidence interval (CI): 68-95 %] and 75.6 % (95 % CI: 68-88 %), respectively. In particular, the use of p53 and methylation in BO patients appeared to be associated with a good diagnostic accuracy to predict neoplastic progression in BE. Therefore, further biomarker research may provide promising results in risk stratification and prediction of progression to HGD and oesophageal adenocarcinoma in context of BE. Conclusions The evidence from this systematic review is suggestive of a crucial role of biomarkers in prediction of BE progression. Further work in translating biomarkers for routine clinical use may eventually lead to accurate risk stratification.