Kavel Visrodia1, Prasad G Iyer2, Cathy D Schleck3, Alan R Zinsmeister3, David A Katzka4. 1. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. 2. Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Avenue SW, Rochester, MN, 55905, USA. iyer.prasad@mayo.edu. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA. 4. Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Avenue SW, Rochester, MN, 55905, USA.
Abstract
BACKGROUND: The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well established. AIMS: To determine how often early repeat endoscopy detected missed dysplasia or esophageal adenocarcinoma (EAC) in a population-based cohort of patients with BE. Secondary aims were to identify risk factors for missed dysplasia/EAC and compare detection of prevalent versus incident HGD/EAC. METHODS: A population-based cohort of BE subjects in Olmsted County, MN, was studied. Patients with initial non-dysplastic BE or low-grade dysplasia (LGD) who underwent repeat endoscopy within 24 months were included. Those with a worse histologic diagnosis on repeat endoscopy were considered to have missed dysplasia/EAC. Baseline characteristics among patients with and without missed dysplasia/EAC were compared. The absolute numbers of asymptomatic prevalent or missed, and incident HGD/EAC in the entire cohort were ascertained. RESULTS: Of 488 BE cases, 210 were included for the primary aim of this study. Repeat endoscopy revealed four HGD/EAC (1.9 %) and 16 LGD (8.8 %) for a combined miss rate of 9.5 %. Long-segment BE (LSBE) and lack of PPI use were predictors of missed dysplasia/EAC (P = 0.008), but adherence to biopsy protocol was not. Increased prevalent HGD/EAC (n = 30) rather than incident HGD/EAC (n = 22) was identified during a median 4.8 years of follow-up in this cohort. CONCLUSIONS: Dysplasia/EAC is commonly missed at initial BE diagnosis, particularly in patients with LSBE and no PPI use. Efforts should be made to enhance the sensitivity of detecting dysplasia/neoplasia around the time of initial BE diagnosis.
BACKGROUND: The yield of early repeat endoscopy in patients with Barrett's esophagus (BE) is not well established. AIMS: To determine how often early repeat endoscopy detected missed dysplasia or esophageal adenocarcinoma (EAC) in a population-based cohort of patients with BE. Secondary aims were to identify risk factors for missed dysplasia/EAC and compare detection of prevalent versus incident HGD/EAC. METHODS: A population-based cohort of BE subjects in Olmsted County, MN, was studied. Patients with initial non-dysplastic BE or low-grade dysplasia (LGD) who underwent repeat endoscopy within 24 months were included. Those with a worse histologic diagnosis on repeat endoscopy were considered to have missed dysplasia/EAC. Baseline characteristics among patients with and without missed dysplasia/EAC were compared. The absolute numbers of asymptomatic prevalent or missed, and incident HGD/EAC in the entire cohort were ascertained. RESULTS: Of 488 BE cases, 210 were included for the primary aim of this study. Repeat endoscopy revealed four HGD/EAC (1.9 %) and 16 LGD (8.8 %) for a combined miss rate of 9.5 %. Long-segment BE (LSBE) and lack of PPI use were predictors of missed dysplasia/EAC (P = 0.008), but adherence to biopsy protocol was not. Increased prevalent HGD/EAC (n = 30) rather than incident HGD/EAC (n = 22) was identified during a median 4.8 years of follow-up in this cohort. CONCLUSIONS:Dysplasia/EAC is commonly missed at initial BE diagnosis, particularly in patients with LSBE and no PPI use. Efforts should be made to enhance the sensitivity of detecting dysplasia/neoplasia around the time of initial BE diagnosis.
Authors: Prateek Sharma; Gary W Falk; Allan P Weston; Dean Reker; Mark Johnston; Richard E Sampliner Journal: Clin Gastroenterol Hepatol Date: 2006-04-17 Impact factor: 11.382
Authors: Prateek Sharma; Kenneth McQuaid; John Dent; M Brian Fennerty; Richard Sampliner; Stuart Spechler; Alan Cameron; Douglas Corley; Gary Falk; John Goldblum; John Hunter; Janusz Jankowski; Lars Lundell; Brian Reid; Nicholas J Shaheen; Amnon Sonnenberg; Kenneth Wang; Wilfred Weinstein Journal: Gastroenterology Date: 2004-07 Impact factor: 22.682
Authors: E Montgomery; M P Bronner; J R Goldblum; J K Greenson; M M Haber; J Hart; L W Lamps; G Y Lauwers; A J Lazenby; D N Lewin; M E Robert; A Y Toledano; Y Shyr; K Washington Journal: Hum Pathol Date: 2001-04 Impact factor: 3.466
Authors: P Moayyedi; N Burch; N Akhtar-Danesh; S K Enaganti; R Harrison; N J Talley; J Jankowski Journal: Aliment Pharmacol Ther Date: 2007-12-06 Impact factor: 8.171
Authors: Revital Kariv; Thomas P Plesec; John R Goldblum; Mary Bronner; Mary Oldenburgh; Thomas W Rice; Gary W Falk Journal: Clin Gastroenterol Hepatol Date: 2008-12-13 Impact factor: 11.382
Authors: Kavel Visrodia; Siddharth Singh; Rajesh Krishnamoorthi; David A Ahlquist; Kenneth K Wang; Prasad G Iyer; David A Katzka Journal: Gastroenterology Date: 2015-11-24 Impact factor: 22.682
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: Margreet van Putten; Brian T Johnston; Liam J Murray; Anna T Gavin; Damian T McManus; Shivaram Bhat; Richard C Turkington; Helen G Coleman Journal: United European Gastroenterol J Date: 2017-10-11 Impact factor: 4.623
Authors: Theresa H Nguyen; Aaron P Thrift; Rollin George; Daniel G Rosen; Hashem B El-Serag; Gyanprakash A Ketwaroo Journal: Clin Gastroenterol Hepatol Date: 2021-04-08 Impact factor: 11.382
Authors: Lovekirat Dhaliwal; D Chamil Codipilly; Parth Gandhi; Michele L Johnson; Ramona Lansing; Kenneth K Wang; Cadman L Leggett; David A Katzka; Prasad G Iyer Journal: Clin Gastroenterol Hepatol Date: 2020-07-21 Impact factor: 11.382