Nour Hamade1, Sreekar Vennelaganti2, Sravanthi Parasa3, Prashanth Vennalaganti1, Srinivas Gaddam4, Manon C W Spaander5, Sophie H van Olphen5, Prashanthi N Thota6, Kevin F Kennedy2, Marco J Bruno5, John J Vargo6, Sharad Mathur2, Brooks D Cash7, Richard Sampliner8, Neil Gupta9, Gary W Falk10, Ajay Bansal11, Patrick E Young12, David A Lieberman13, Prateek Sharma14. 1. Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas; Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri. 2. Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri. 3. Division of Gastroenterology, Swedish Medical Group, Seattle, Washington. 4. Division of Gastroenterology, Cedars Sinai Medical Center, Los Angeles, California. 5. Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, the Netherlands. 6. Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio. 7. Division of Gastroenterology, Hepatology, and Nutrition, University of South Alabama, Mobile, Alabama. 8. Department of Gastroenterology and Hepatology, University of Arizona, Tucson, Arizona. 9. Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois. 10. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 11. Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas. 12. Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland. 13. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon. 14. Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas; Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri. Electronic address: psharma@kumc.edu.
Abstract
BACKGROUND & AIMS: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). METHODS: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. RESULTS: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P = .001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P < .001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18-0.57; P < .001). CONCLUSION: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
BACKGROUND & AIMS: European guidelines recommend different surveillance intervals of non-dysplastic Barrett's esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). METHODS: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and <3) and long (≥3) BE lengths using log-rank tests. A subgroup analysis was performed on patients with a documented Prague C&M classification. We used a multivariable proportional hazards model to evaluate the association between BE length and progression. Adjusted hazards ratios were calculated after adjusting for variables associated with progression. RESULTS: We found 822 patients to have a short-segment BE (SSBE) and 1061 to have long segment BE (LSBE). We found patients with SSBE to have a significantly lower annual rate of progression to EAC (0.07%) than of patients with LSBE (0.25%) (P = .001). For the combined endpoint of HGD or EAC, annual progression rates were significantly lower among patients with SSBE (0.29%) compared to compared to LSBE (0.91%) (P < .001). This effect persisted in multivariable analysis (hazard ratio, 0.32; 95% CI, 0.18-0.57; P < .001). CONCLUSION: We analyzed progression of BE (length ≥1 cm) to HGD or EAC in a large cohort of patients seen at multiple centers and followed for a median 6.4 years. We found a lower annual rate of progression of SSBE to EAC (0.07%/year) than of LSBE (0.25%/year). We propose lengthening current surveillance intervals for patients with SSBE.
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