STATUS: Sessioned Background: Esophageal adenocarcinoma (EAC) continues to be one of the fastest rising incident cancers. However, the overall risk of progression to HGD and EAC in pts with BE is low. Identifying pts at risk of progression may help tailor management. Aim: In a large multi-center cohort of BE pts undergoing screening/surveillance to: -Identify predictors for HGD/EAC development. -Formulate an equation/score capable of predicting pts likely to harbor or progress to HGD/ EAC Methods: This is a prospective, multicenter outcomes project (5 centers) involving BE pts. BE diagnosis required intestinal metaplasia on histology. Demographics, medication use, family history, and endoscopy results were recorded. Time of LGD, HGD, and EAC detection was recorded. Assuming that the clinical and demographic factors of pts who develop HGD/ EAC while in surveillance should be no different than pts presenting with HGD/EAC, the endpoint included both prevalent and incident cases. Univariate analysis using Chi-square and Mann-Whitney U test identified predictors for prevalent and incident HGD/EAC. LRM was developed with factors significant on univariate analysis. Missing Variable Analysis was performed (Little's MCAR test ,0.01) and missing values were computed by multiple imputation. Receiver Operating Characteristic (ROC) curve of the prediction score was plotted to determine the best cut-off value. Results: 3677 pts were included [87.6% males, 94.9% Caucasians, mean BMI 28.3 (SD 5.7), mean age 60.8 (SD 12.3), and mean BE length 3.5 cm (SD 3.1)]. 348 prevalent and 75 incident cases of HGD/ EAC were recorded and compared to pts without HGD/EAC. On univariate analysis age, BMI, BE length, current/past smoking history, lack of aspirin or NSAID use, hiatal hernia, number of consecutive EGDs showing nondysplastic Barrett's Esophagus (NDBE), and presence of visible lesions within the BE segment were significantly associated with HGD/EAC. A statistically significant LRM (Nagelkerke R square = 0.31) resulted in the following equation for prediction score (Table): Y = (0 .019*Age)+(0 .864*Caucasian race)+(0 .538*Male gender)+(0.050*BE length)+(1.139*visible lesion)+(0.322*Presence of hiatal hernia)+(-0.674*Number of consecutive EGDs showing NDBE)-4.416. A cut-off for optimal performance of the prediction model was determined by plotting an ROC curve using the prediction score [AUROC = 0.877 (95% CI 0.86–0.90),p=0.01]. Prediction score cut off at 0.0937 yielded the best sensitivity (90%) and specificity (69%) (Figure). Conclusions: Using demographic and endoscopic risk factors from a large cohort of more than 3500 patients, we have developed a prediction model with an AUC of 0.877. If this prediction model is successfully externally validated, using a progression score, high risk BE patients could be identified leading to tailored management of these patients. A G A A b st ra ct s