Siddharth Singh1, Palaniappan Manickam2, Anita V Amin2, Niharika Samala2, Leo J Schouten3, Prasad G Iyer1, Tusar K Desai2. 1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. 2. Department of Internal Medicine, William Beaumont Hospital/Oakland University School of Medicine, Royal Oak, Michigan, USA. 3. Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, The Netherlands.
Abstract
BACKGROUND: The natural history of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE) is unclear. OBJECTIVE: We performed a systematic review and meta-analysis of studies that reported the incidence of esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) among patients with BE with LGD. DESIGN: Systematic review and meta-analysis of cohort studies. PATIENTS: Patients with BE-LGD, with mean cohort follow-up ≥ 2 years. MAIN OUTCOME MEASUREMENTS: Pooled incidence rates with 95% confidence intervals (CI) of EAC and/or BE-HGD. RESULTS: We identified 24 studies reporting on 2694 patients with BE-LGD, with 119 cases of EAC. Pooled annual incidence rates of EAC alone and EAC and/or HGD in patients with BE-LGD were 0.54% (95% CI, 0.32-0.76; 24 studies) and 1.73% (95% CI, 0.99-2.47; 17 studies). The results were stable across study setting and location and in high-quality studies. Substantial heterogeneity was observed, which could be explained by stratifying based on LGD/BE ratio as a surrogate for quality of pathology; the pooled annual incidence rates of EAC were 0.76% (95% CI, 0.44-1.09; 14 studies) for LGD/BE ratio <0.15 and 0.32% (95% CI, 0.07-0.58; 10 studies) for LGD/BE ratio >0.15. The annual rate of mortality not related to esophageal disease in patients with BE-LGD was 4.7% (95% CI, 3.2-6.2; 4 studies). LIMITATIONS: Substantial heterogeneity was observed in the overall analysis. CONCLUSION: The incidence of EAC among patients with BE-LGD is 0.54% annually. The LGD/BE ratio appears to explain the variation observed in the reported incidence of EAC in different cohorts. Conditions not related to esophageal disease are a major cause of mortality in patients with BE-LGD, although additional studies are warranted.
BACKGROUND: The natural history of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE) is unclear. OBJECTIVE: We performed a systematic review and meta-analysis of studies that reported the incidence of esophageal adenocarcinoma (EAC) and/or high-grade dysplasia (HGD) among patients with BE with LGD. DESIGN: Systematic review and meta-analysis of cohort studies. PATIENTS: Patients with BE-LGD, with mean cohort follow-up ≥ 2 years. MAIN OUTCOME MEASUREMENTS: Pooled incidence rates with 95% confidence intervals (CI) of EAC and/or BE-HGD. RESULTS: We identified 24 studies reporting on 2694 patients with BE-LGD, with 119 cases of EAC. Pooled annual incidence rates of EAC alone and EAC and/or HGD in patients with BE-LGD were 0.54% (95% CI, 0.32-0.76; 24 studies) and 1.73% (95% CI, 0.99-2.47; 17 studies). The results were stable across study setting and location and in high-quality studies. Substantial heterogeneity was observed, which could be explained by stratifying based on LGD/BE ratio as a surrogate for quality of pathology; the pooled annual incidence rates of EAC were 0.76% (95% CI, 0.44-1.09; 14 studies) for LGD/BE ratio <0.15 and 0.32% (95% CI, 0.07-0.58; 10 studies) for LGD/BE ratio >0.15. The annual rate of mortality not related to esophageal disease in patients with BE-LGD was 4.7% (95% CI, 3.2-6.2; 4 studies). LIMITATIONS: Substantial heterogeneity was observed in the overall analysis. CONCLUSION: The incidence of EAC among patients with BE-LGD is 0.54% annually. The LGD/BE ratio appears to explain the variation observed in the reported incidence of EAC in different cohorts. Conditions not related to esophageal disease are a major cause of mortality in patients with BE-LGD, although additional studies are warranted.
Authors: Rajesh Krishnamoorthi; Jason T Lewis; Murli Krishna; Nicholas J Crews; Michele L Johnson; Ross A Dierkhising; Brenda F Ginos; Kenneth K Wang; Herbert C Wolfsen; David E Fleischer; Francisco C Ramirez; Navtej S Buttar; David A Katzka; Prasad G Iyer Journal: Am J Gastroenterol Date: 2017-04-04 Impact factor: 10.864
Authors: Aaron J Small; James L Araujo; Cadman L Leggett; Aaron H Mendelson; Anant Agarwalla; Julian A Abrams; Charles J Lightdale; Timothy C Wang; Prasad G Iyer; Kenneth K Wang; Anil K Rustgi; Gregory G Ginsberg; Kimberly A Forde; Phyllis A Gimotty; James D Lewis; Gary W Falk; Meenakshi Bewtra Journal: Gastroenterology Date: 2015-04-24 Impact factor: 22.682