Significance of Persistent Nondysplasia Over Multiple Endoscopic Surveillance in Risk Stratification of Patients With Barrett's Esophagus (Gastroenterology 2013;145:548-553, e1)

Abstract

Gaddam et al1 has reported a study entitled Persistence of nondysplastic Barrett's esophagus (BE) identifies patients at lower risk for esophageal adenocarcinoma (EAC): results from a large multicenter cohort. in the September issue of Gastroenterology 2013. Using outcomes of a large multicenter cohort study of patients with BE, the authors evaluated how the persistence of BE without dysplasia over multiple consecutive surveillance using esophagogastroduodenoscopic examinations could have an effect in risk stratification of patients with BE. Based on the number of consecutive surveillance endoscopies presenting BE without dysplasia, they identified 5 groups of patients with BE without dysplasia. Group 1 was determined as the patients with BE without dysplasia at their first esophagogastroduodenoscopy (EGD). Group 2 was determined as the patients with BE without dysplasia at their first 2 consecutive EGDs. Similarly, groups 3, 4 and 5 were determined as the patients with BE without dysplasia at 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was used to determine whether the persistence of BE without dysplasia had independent effect for the development of esophageal high grade dysplasia (HGD) and/or EAC. In results, a total of 1,401 patients with BE were finally included (median follow-up period; 5.0 ± 3.9 years). The annual risk of HGD and/or EAC in group 1 (n = 1,401), group 2 (n = 826), group 3 (n = 484), group 4 (n = 280) and group 5 (n = 173) was 0.75%, 0.57%, 0.41%, 0.44% and 0.00%, respectively (P for trend = 0.021). The persistence of BE without dysplasia, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to HGD and/or EAC (OR, 0.67; 95% CI, 0.51-0.91; P < 0.01), after adjusting for age, sex and length of BE. Through these results, the authors suggested that the persistence of BE without dysplasia over several endoscopic examinations could identify patients who are at low risk for development of HGD and/or EAC, and after all, these findings support lengthening surveillance intervals or discontinuing surveillance in the patients with persistence of BE without dysplasia.