Sravanthi Parasa1, Sreekar Vennalaganti2, Srinivas Gaddam3, Prashanth Vennalaganti4, Patrick Young5, Neil Gupta6, Prashanthi Thota7, Brooks Cash8, Sharad Mathur2, Richard Sampliner9, Fouad Moawad5, David Lieberman10, Ajay Bansal4, Kevin F Kennedy2, John Vargo7, Gary Falk11, Manon Spaander12, Marco Bruno12, Prateek Sharma13. 1. Division of Gastroenterology, Swedish Medical Group, Seattle, Washington. 2. Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri. 3. Division of Gastroenterology, Cedar-Sinai Medical Center, Los Angeles, California. 4. Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas. 5. Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland. 6. Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois. 7. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio. 8. University of South Alabama, Mobile, Alabama; American Gastroenterological Association. 9. Department of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona. 10. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon. 11. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 12. Department of Gastroenterology, Erasmus Medical Centre, Rotterdam, Netherlands. 13. Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas. Electronic address: psharma@kumc.edu.
Abstract
BACKGROUND & AIMS: A system is needed to determine the risk of patients with Barrett's esophagus for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). We developed and validated a model to determine of progression to HGD or EAC in patients with BE, based on demographic data and endoscopic and histologic findings at the time of index endoscopy. METHODS: We performed a longitudinal study of patients with BE at 5 centers in United States and 1 center in Netherlands enrolled in the Barrett's Esophagus Study database from 1985 through 2014. Patients were excluded from the analysis if they had less than 1 year of follow-up, were diagnosed with HGD or EAC within the past year, were missing baseline histologic data, or had no intestinal metaplasia. Seventy percent of the patients were used to derive the model and 30% were used for the validation study. The primary outcome was development of HGD or EAC during the follow-up period (median, 5.9 years). Survival analysis was performed using the Kaplan-Meier method. We assigned a specific number of points to each BE risk factor, and point totals (scores) were used to create categories of low, intermediate, and high risk. We used Cox regression to compute hazard ratios and 95% confidence intervals to determine associations between risk of progression and scores. RESULTS: Of 4584 patients in the database, 2697 were included in our analysis (84.1% men; 87.6% Caucasian; mean age, 55.4 ± 20.1 years; mean body mass index, 27.9 ± 5.5 kg/m2; mean length of BE, 3.7 ± 3.2 cm). During the follow-up period, 154 patients (5.7%) developed HGD or EAC, with an annual rate of progression of 0.95%. Male sex, smoking, length of BE, and baseline-confirmed low-grade dysplasia were significantly associated with progression. Scores assigned identified patients with BE that progressed to HGD or EAC with a c-statistic of 0.76 (95% confidence interval, 0.72-0.80; P < .001). The calibration slope was 0.9966 (P = .99), determined from the validation cohort. CONCLUSIONS: We developed a scoring system (Progression in Barrett's Esophagus score) based on male sex, smoking, length of BE, and baseline low-grade dysplasia that identified patients with BE at low, intermediate, and high risk for HGD or EAC. This scoring system might be used in management of patients.
BACKGROUND & AIMS: A system is needed to determine the risk of patients with Barrett's esophagus for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). We developed and validated a model to determine of progression to HGD or EAC in patients with BE, based on demographic data and endoscopic and histologic findings at the time of index endoscopy. METHODS: We performed a longitudinal study of patients with BE at 5 centers in United States and 1 center in Netherlands enrolled in the Barrett's Esophagus Study database from 1985 through 2014. Patients were excluded from the analysis if they had less than 1 year of follow-up, were diagnosed with HGD or EAC within the past year, were missing baseline histologic data, or had no intestinal metaplasia. Seventy percent of the patients were used to derive the model and 30% were used for the validation study. The primary outcome was development of HGD or EAC during the follow-up period (median, 5.9 years). Survival analysis was performed using the Kaplan-Meier method. We assigned a specific number of points to each BE risk factor, and point totals (scores) were used to create categories of low, intermediate, and high risk. We used Cox regression to compute hazard ratios and 95% confidence intervals to determine associations between risk of progression and scores. RESULTS: Of 4584 patients in the database, 2697 were included in our analysis (84.1% men; 87.6% Caucasian; mean age, 55.4 ± 20.1 years; mean body mass index, 27.9 ± 5.5 kg/m2; mean length of BE, 3.7 ± 3.2 cm). During the follow-up period, 154 patients (5.7%) developed HGD or EAC, with an annual rate of progression of 0.95%. Male sex, smoking, length of BE, and baseline-confirmed low-grade dysplasia were significantly associated with progression. Scores assigned identified patients with BE that progressed to HGD or EAC with a c-statistic of 0.76 (95% confidence interval, 0.72-0.80; P < .001). The calibration slope was 0.9966 (P = .99), determined from the validation cohort. CONCLUSIONS: We developed a scoring system (Progression in Barrett's Esophagus score) based on male sex, smoking, length of BE, and baseline low-grade dysplasia that identified patients with BE at low, intermediate, and high risk for HGD or EAC. This scoring system might be used in management of patients.
Authors: Jon M Davison; John Goldblum; Udhayvir Singh Grewal; Kevin McGrath; Kenneth Fasanella; Christopher Deitrick; Aaron D DeWard; Emily A Bossart; Stephen L Hayward; Yi Zhang; Rebecca J Critchley-Thorne; Prashanthi N Thota Journal: Am J Gastroenterol Date: 2020-06 Impact factor: 12.045
Authors: Nour Hamade; Amrit K Kamboj; Rajesh Krishnamoorthi; Siddharth Singh; Leslie C Hassett; David A Katzka; Charles J Kahi; Hala Fatima; Prasad G Iyer Journal: Aliment Pharmacol Ther Date: 2021-07-18 Impact factor: 9.524