Theresa H Nguyen1, Aaron P Thrift2, Rollin George3, Daniel G Rosen4, Hashem B El-Serag1, Gyanprakash A Ketwaroo5. 1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. 2. Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas; Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas. 3. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas. 4. Department of Pathology, Baylor College of Medicine, Houston, Texas. 5. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas. Electronic address: gyanprakash.ketwaroo@bcm.edu.
Abstract
BACKGROUND & AIMS: Limitations of endoscopic sampling may result in missed dysplasia at the diagnosis of Barrett's esophagus (BE). However, the role of close follow-up endoscopy is unclear. The aim was to evaluate the proportion of patients diagnosed with "missed" dysplasia within 18 months of their index nondysplastic BE (NDBE) diagnosis. METHODS: This was a retrospective analysis of a cohort of BE patients diagnosed during 1990-2019 at the Houston VA. Patients with BE on index esophagogastroduodenoscopy (EGD) were classified as NDBE, indefinite dysplasia, or dysplastic (low- or high-grade dysplasia) based on initial biopsies. We identified NDBE patients who had follow-up EGD within 3-18 months after index EGD. We used logistic regression models to estimate odds ratios and 95% confidence intervals for risk factors of dysplasia on follow-up EGD. RESULTS: We identified 614 patients who had BE on index EGD. Among those with NDBE and follow-up EGD within 3-18 months (n = 271), 4.1% had definite dysplasia on follow-up, and an additional 14.0% had indefinite dysplasia. Proportions of definite or indefinite dysplasia at follow-up within 3-18 months significantly decreased from 32.6% among patients with index EGD before 2009 to 11.7% among patients with index EGD after 2013 (P for trend = .068). Those with any indefinite or definite dysplastic BE at follow-up within 3-18 months after index EGD (n = 49) were more likely to have BE length ≥3 cm on index EGD (odds ratio, 3.39; 95% confidence interval, 1.63-7.08) than those with persistent NDBE or no BE on follow-up. CONCLUSIONS: The occurrence of missed dysplasia on an index EGD has decreased over time. However, those with long segment BE were more than 3 times as likely to have missed dysplasia, and this group could benefit from dysplasia surveillance within 18 months of BE diagnosis.
BACKGROUND & AIMS: Limitations of endoscopic sampling may result in missed dysplasia at the diagnosis of Barrett's esophagus (BE). However, the role of close follow-up endoscopy is unclear. The aim was to evaluate the proportion of patients diagnosed with "missed" dysplasia within 18 months of their index nondysplastic BE (NDBE) diagnosis. METHODS: This was a retrospective analysis of a cohort of BE patients diagnosed during 1990-2019 at the Houston VA. Patients with BE on index esophagogastroduodenoscopy (EGD) were classified as NDBE, indefinite dysplasia, or dysplastic (low- or high-grade dysplasia) based on initial biopsies. We identified NDBE patients who had follow-up EGD within 3-18 months after index EGD. We used logistic regression models to estimate odds ratios and 95% confidence intervals for risk factors of dysplasia on follow-up EGD. RESULTS: We identified 614 patients who had BE on index EGD. Among those with NDBE and follow-up EGD within 3-18 months (n = 271), 4.1% had definite dysplasia on follow-up, and an additional 14.0% had indefinite dysplasia. Proportions of definite or indefinite dysplasia at follow-up within 3-18 months significantly decreased from 32.6% among patients with index EGD before 2009 to 11.7% among patients with index EGD after 2013 (P for trend = .068). Those with any indefinite or definite dysplastic BE at follow-up within 3-18 months after index EGD (n = 49) were more likely to have BE length ≥3 cm on index EGD (odds ratio, 3.39; 95% confidence interval, 1.63-7.08) than those with persistent NDBE or no BE on follow-up. CONCLUSIONS: The occurrence of missed dysplasia on an index EGD has decreased over time. However, those with long segment BE were more than 3 times as likely to have missed dysplasia, and this group could benefit from dysplasia surveillance within 18 months of BE diagnosis.
Authors: Hashem B El-Serag; Harinder Garewel; Mark Kuebeler; Richard E Sampliner Journal: Clin Gastroenterol Hepatol Date: 2004-04 Impact factor: 11.382
Authors: Stuart J Spechler; Prateek Sharma; Rhonda F Souza; John M Inadomi; Nicholas J Shaheen Journal: Gastroenterology Date: 2011-03 Impact factor: 22.682
Authors: Bashar Qumseya; Shahnaz Sultan; Paul Bain; Laith Jamil; Brian Jacobson; Sharmila Anandasabapathy; Deepak Agrawal; James L Buxbaum; Douglas S Fishman; Suryakanth R Gurudu; Terry L Jue; Sapna Kripalani; Jeffrey K Lee; Mouen A Khashab; Mariam Naveed; Nirav C Thosani; Julie Yang; John DeWitt; Sachin Wani Journal: Gastrointest Endosc Date: 2019-09 Impact factor: 9.427
Authors: Myrtle J van der Wel; Helen G Coleman; Jacques J G H M Bergman; Marnix Jansen; Sybren L Meijer Journal: Gut Date: 2019-12-18 Impact factor: 23.059
Authors: Prateek Sharma; John Dent; David Armstrong; Jacques J G H M Bergman; Liebwin Gossner; Yoshio Hoshihara; Janusz A Jankowski; Ola Junghard; Lars Lundell; Guido N J Tytgat; Michael Vieth Journal: Gastroenterology Date: 2006-08-16 Impact factor: 22.682
Authors: Tusar K Desai; Kumar Krishnan; Niharika Samala; Jashanpreet Singh; John Cluley; Subaiah Perla; Colin W Howden Journal: Gut Date: 2011-10-13 Impact factor: 23.059
Authors: Nastazja Dagny Pilonis; Sarah Killcoyne; W Keith Tan; Maria O'Donovan; Shalini Malhotra; Monika Tripathi; Ahmad Miremadi; Irene Debiram-Beecham; Tara Evans; Rosemary Phillips; Danielle L Morris; Craig Vickery; Jon Harrison; Massimiliano di Pietro; Jacobo Ortiz-Fernandez-Sordo; Rehan Haidry; Abigail Kerridge; Peter D Sasieni; Rebecca C Fitzgerald Journal: Lancet Oncol Date: 2022-01-11 Impact factor: 41.316