Lucas C Duits1, Myrtle J van der Wel2, Cary C Cotton3, K Nadine Phoa1, Fiebo J W Ten Kate4, Cees A Seldenrijk5, G Johan A Offerhaus4, Mike Visser3, Sybren L Meijer3, Rosalie C Mallant-Hent6, Kausilia K Krishnadath1, Roos E Pouw1, Jan G P Tijssen7, Nicholas J Shaheen3, Jacques J G H M Bergman8. 1. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands. 3. Center for Esophageal Diseases and Swallowing, Department of Medicine, Division of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 4. Center for Esophageal Diseases and Swallowing, Department of Medicine, Division of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Pathology, University Medical Center, Utrecht, The Netherlands. 5. Department of Pathology, St Antonius Hospital, Nieuwegein, The Netherlands. 6. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands. 7. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 8. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.j.bergman@amc.uva.nl.
Abstract
BACKGROUND & AIMS: For patients with Barrett's esophagus, the diagnosis of low-grade dysplasia (LGD) is subjective, and reported outcomes vary. We analyzed data from a multicenter study of endoscopic therapy to identify factors associated with progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with LGD of the esophagus. METHODS: We performed a retrospective analysis of data from 255 patients with a primary diagnosis of LGD (78% men; mean age, 63 years) who participated in a randomized controlled trial of surveillance vs radiofrequency ablation in Europe. Three expert pathologists independently reviewed baseline and subsequent LGD specimens. The presence and degree of dysplasia was separately recorded for each biopsy and classified according to the Vienna Classification system. The primary end point was development of HGD or EAC. We performed univariate logistic regression analyses to assess the association between outcomes and factors such as number of pathologists confirming LGD, multifocality of LGD, and persistence of LGD over time. RESULTS: Of the 255 patients, 45 (18%) developed HGD or EAC during a median 42-month follow-up period (interquartile range, 25-61 months); patients were examined by a median 4 endoscopies (interquartile range, 3-6 endoscopies). The number of pathologists confirming LGD was strongly associated with progression to neoplasia; risk for progression increased greatly when all 3 pathologists agreed on LGD (odds ratio, 47.14; 95% confidence interval, 13.10-169.70). When LGD was detected at baseline and confirmed by a subsequent endoscopy, the odds for progression to neoplasia also increased greatly (odds ratio, 9.28; 95% confidence interval, 4.39-19.64). Multifocal LGD was not significantly associated with progression to neoplasia. CONCLUSIONS: The number of pathologists confirming LGD and persistence of LGD over time increase risk for development of HGD or EAC in patients with Barrett's esophagus and LGD. These simple, readily available variables can help stratify risk and select patients for prophylactic ablation therapy.
BACKGROUND & AIMS: For patients with Barrett's esophagus, the diagnosis of low-grade dysplasia (LGD) is subjective, and reported outcomes vary. We analyzed data from a multicenter study of endoscopic therapy to identify factors associated with progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with LGD of the esophagus. METHODS: We performed a retrospective analysis of data from 255 patients with a primary diagnosis of LGD (78% men; mean age, 63 years) who participated in a randomized controlled trial of surveillance vs radiofrequency ablation in Europe. Three expert pathologists independently reviewed baseline and subsequent LGD specimens. The presence and degree of dysplasia was separately recorded for each biopsy and classified according to the Vienna Classification system. The primary end point was development of HGD or EAC. We performed univariate logistic regression analyses to assess the association between outcomes and factors such as number of pathologists confirming LGD, multifocality of LGD, and persistence of LGD over time. RESULTS: Of the 255 patients, 45 (18%) developed HGD or EAC during a median 42-month follow-up period (interquartile range, 25-61 months); patients were examined by a median 4 endoscopies (interquartile range, 3-6 endoscopies). The number of pathologists confirming LGD was strongly associated with progression to neoplasia; risk for progression increased greatly when all 3 pathologists agreed on LGD (odds ratio, 47.14; 95% confidence interval, 13.10-169.70). When LGD was detected at baseline and confirmed by a subsequent endoscopy, the odds for progression to neoplasia also increased greatly (odds ratio, 9.28; 95% confidence interval, 4.39-19.64). Multifocal LGD was not significantly associated with progression to neoplasia. CONCLUSIONS: The number of pathologists confirming LGD and persistence of LGD over time increase risk for development of HGD or EAC in patients with Barrett's esophagus and LGD. These simple, readily available variables can help stratify risk and select patients for prophylactic ablation therapy.
Authors: Matthew D Stachler; Nicholas D Camarda; Christopher Deitrick; Anthony Kim; Agoston T Agoston; Robert D Odze; Jason L Hornick; Anwesha Nag; Aaron R Thorner; Matthew Ducar; Amy Noffsinger; Richard H Lash; Mark Redston; Scott L Carter; Jon M Davison; Adam J Bass Journal: Gastroenterology Date: 2018-03-31 Impact factor: 22.682
Authors: M J van der Wel; L C Duits; E Klaver; R E Pouw; C A Seldenrijk; Gja Offerhaus; M Visser; Fjw Ten Kate; J G Tijssen; Jjghm Bergman; S L Meijer Journal: United European Gastroenterol J Date: 2018-03-07 Impact factor: 4.623