Sa1855 Cost-Effectiveness of Barrett's Esophagus Surveillance in a Prospective Followed Cohort in the Netherlands

Abstract

study aimed to identify predictors of neoplastic progression in this patient group by assessing their demographic, clinical and endoscopic parameters at the time of the diagnosis of IND. Our surgical pathology database from 1992 to 2007 was searched for BE and IND. A total of 225 BE patients with a diagnosis of IND were identified. 118 cases were excluded due to a prior or concurrent diagnosis of neoplasia (N=70), being lost to follow-up (FU) (N= 37), missing slides or lack of BE (N=11). FU data of 107 patients were obtained; neoplasia diagnosed within the first FU year was considered as prevalent dysplasia; neoplasia occurred beyond the first FU year was classified as incident neoplasia (progression). BE IND patients with prevalent neoplasia were also excluded. Progression rates were calculated and univariate analysis was performed to identify predictors for neoplasia progression in BE IND patients. Among 82 patients, who did not have prevalent neoplasia but had ≥1 year FU, 17 progressed to dysplasia (14 low-grade dysplasia (LGD), 3 high-grade dysplasia (HGD))and 2 developed EAD during a FU period of 421.4 patient years. The incidence of neoplasia (LGD, HGD or EAD) and advanced neoplasia (HGD+EAD) was 4.51 and 1.19 cases per 100 patient years. Longer length of BE was associated with progression to neoplasia (Table 1). Patients with progression had a trend of having a longer duration of BE, history of smoking and PPI use (Table 1). BE IND has a significant risk of progression to neoplasia including HGD and carcinoma; a longer length of BE is associated with neoplasia progression in this patient population. Table 1.