Prashanthi N Thota1, Prashanth Vennalaganti2, Sreekar Vennelaganti3, Patrick Young4, Srinivas Gaddam5, Neil Gupta6, David Lieberman7, Richard Sampliner8, Gary W Falk9, Sharad Mathur3, Kevin Kennedy3, Brooks D Cash10, Fouad Moawad4, Ajay Bansal3, Manon C Spaander11, Marco J Bruno11, John Vargo12, Prateek Sharma13. 1. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio. Electronic address: thotap@ccf.org. 2. Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas. 3. Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri. 4. Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland. 5. Department of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California. 6. Department of Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, Illinois. 7. Department of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon. 8. Department of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona. 9. Department of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 10. Department of Gastroenterology and Hepatology, University of South Alabama, Mobile, Alabama. 11. Department of Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, Netherlands. 12. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio. 13. Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas; Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri.
Abstract
BACKGROUND & AIMS: Many patients with a < 1 cm segment of columnar metaplasia in the distal esophagus, also called an irregular Z line, are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia. METHODS: We performed a prospective, multicenter cohort study of patients who underwent endoscopic examination for BE at tertiary care referral centers in the United States and Europe. We analyzed data from 1791 patients (mean age, 56 ± 17 years) found to have non-dysplastic BE at the index endoscopy and after 1 year or more of follow-up. Patients were followed for a median of 5.9 years (interquartile range, 3.1-8.3 years). We calculated rates of progression to HGD or EAC between groups of patients with irregular Z line (n = 167) and those with BE of ≥ 1 cm (n = 1624). RESULTS: A higher proportion of patients in the irregular Z-line group were female (26.3%) than in the BE group (14.8% female BE) (P <.001). A lower proportion of patients in the irregular Z-line group were smokers (33.5%) than in the BE group (52.6% smokers). None of the patients with irregular Z line developed HGD or EAC during a median follow-up period of 4.8 years (interquartile range, 3.2-8.3 years). All 71 incident cases of HGD or EAC developed in patients with BE of ≥1 cm in length. On multivariate analysis, patients with irregular Z line and patients with BE of ≥ 1 cm did not differ significantly in age, race, or duration of follow-up. CONCLUSIONS: In a prospective, multicenter cohort study, we found that patients with irregular Z line do not develop HGD or esophageal cancer within 5 years after index endoscopy.
BACKGROUND & AIMS: Many patients with a < 1 cm segment of columnar metaplasia in the distal esophagus, also called an irregular Z line, are encountered. These patients, often referred to as patients with Barrett's esophagus (BE), are enrolled in surveillance programs. However, little is known about their risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We aimed to determine the incidence of HGD and EAC in patients with irregular Z line with intestinal metaplasia. METHODS: We performed a prospective, multicenter cohort study of patients who underwent endoscopic examination for BE at tertiary care referral centers in the United States and Europe. We analyzed data from 1791 patients (mean age, 56 ± 17 years) found to have non-dysplastic BE at the index endoscopy and after 1 year or more of follow-up. Patients were followed for a median of 5.9 years (interquartile range, 3.1-8.3 years). We calculated rates of progression to HGD or EAC between groups of patients with irregular Z line (n = 167) and those with BE of ≥ 1 cm (n = 1624). RESULTS: A higher proportion of patients in the irregular Z-line group were female (26.3%) than in the BE group (14.8% female BE) (P <.001). A lower proportion of patients in the irregular Z-line group were smokers (33.5%) than in the BE group (52.6% smokers). None of the patients with irregular Z line developed HGD or EAC during a median follow-up period of 4.8 years (interquartile range, 3.2-8.3 years). All 71 incident cases of HGD or EAC developed in patients with BE of ≥1 cm in length. On multivariate analysis, patients with irregular Z line and patients with BE of ≥ 1 cm did not differ significantly in age, race, or duration of follow-up. CONCLUSIONS: In a prospective, multicenter cohort study, we found that patients with irregular Z line do not develop HGD or esophageal cancer within 5 years after index endoscopy.
Authors: Madhav Desai; David A Lieberman; Kevin F Kennedy; Nour Hamade; Prashanthi Thota; Sravanthi Parasa; Venkat Subhash Gorrepati; Ajay Bansal; Neil Gupta; Srinivas Gaddam; Patrick E Young; Sharad Mathur; Fouad J Moawad; Brooks D Cash; Richard Sampliner; John J Vargo; Gary W Falk; Prateek Sharma Journal: Gastrointest Endosc Date: 2018-10-17 Impact factor: 9.427
Authors: Lu Zhang; Binyu Sun; Xi Zhou; QiongQiong Wei; Sicheng Liang; Gang Luo; Tao Li; Muhan Lü Journal: Front Oncol Date: 2021-06-17 Impact factor: 6.244