Temporal Change in Barrett's Esophagus Segment Length (BESL) During Prospective Surveillance

Abstract

Background: Few studies have explored changes in BESL during prospective endoscopic surveillance. The aim of this study was to investigate BESL changes during prospective surveillance and factors contributing to BESL change. Methods: Endoscopic landmarks were followed prospectively in 467 patients for an average of 5 years and changes in BESL were monitored at well-defined endoscopic intervals and recorded in a database. Individuals with BESL change outside of the expected statistical variation during follow-up were further analyzed for contributing patient and environmental factors. Results: 79 of the 467 patients (17%) had significant change in BESL during follow-up whereas the BESL remained stable in 338 patients (83%). There was no statistical difference in BESL changes between males and females (two tail t-test p >0.2). There was also no significant difference between rates of BESL change for those patients who were followed for <2 years compared to those followed for >6 years. No significant changes occurred in the BESL rate of change as a function of baseline segment length. Total regression of the BE segment was significantly associated with a smaller hiatal hernia (p<0.0001). Additionally, the mean baseline BESL of those patients who had total regression of their BE segment was significantly shorter as compared to patients without complete regression (2.4cm vs. 5.8cm; p<0.001). However, there was no significant difference in hiatal hernia size among patients whose BESL increased, remained stable, or decreased. There was a significant association between the duration of PPI use and the rate of decrease of BESL (p trend = 0.027). Conclusions: (1) Most BESLs remain stable during prospective follow-up. (2) Smaller hiatal hernia and shorter baseline BESL increase a patient's likelihood of complete regression of BE. (3) Extended treatment with PPIs appears to contribute to decreased BESL. (4) Patient gender and the length of follow-up do not seem to affect the rate of change of a Barrett's segment length.