Re: Risk of Malignant Progression in Barrett's Esophagus Patients: Results from a Large Population-Based Study

Abstract

Bhat’s article (1) and its accompanying editorial (2) addressed the screening and/or surveillance strategies for Barrett’s esophagus (BE). We agree that the incidence of Barrett’s adenocarcinoma (BAc) is lower than that previously claimed (1,3). Consistent with data, variable endoscopy/biopsy protocols and inconsistent endoscopist–pathologist interactions substantially affect the assessment and reported prevalence of this disease (4,5). Unequivocal definitions, educational programs, and audited interdisciplinary teamwork are needed to obtain more reliable information, as demonstrated by our seven-year experience with a multicenter BE registry (the Esofago di Barrett e Rischio di Adenocarcinoma [EBRA] in Northeast Italy) (4,5). This registry, which is restricted to the records of intestinalized-BE patients and excludes patients with cancers that were diagnosed within a year of enrollment, currently includes 841 patients, with a median followup of 44.6 months or 3 058 patient-years (6). The incidence of high-grade dysplasia (HGD) is 4.9 (95% confidence interval [CI] = 2.7 to 8.1) patients per 1 000 person-years, and the incidence of BAc is 2.3 (95% CI = 0.9 to 4.7) patients per 1 000 person-years. Among patients with low-grade dysplasia, 32.0 (95% CI = 12.7 to 65.3) per 1 000 patient-years will progress to HG-D or BAc. These prospectively collected data lie between the earlier “enthusiastic” figures and Bhat’s “pessimistic” findings. Interestingly, Bhat’s findings and our own experience with the EBRA consistently demonstrate that the BE planet has so far been only partially explored.