Medline ® Abstract for Reference 39
of 'Barrett's esophagus: Surveillance and management'
Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia: a nationwide cohort study.
Kestens C, Leenders M, Offerhaus GJ, van Baal JW, Siersema PD
BACKGROUND AND STUDY AIMS: A histological diagnosis of "indefinite for dysplasia" (IND) in Barrett's esophagus is used when a diagnosis of genuine dysplasia is equivocal. The aim of the present study was to assess the risk of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) after a diagnosis of IND in a nationwide cohort of patients with Barrett's esophagus.
PATIENTS AND METHODS: Patients with a first diagnosis of IND in Barrett's esophagus between 2002 and 2011 were selected from a nationwide registry of histopathology diagnoses in The Netherlands. Patients were followed up until treatment for HGD, detection of EAC, or date of last endoscopy contact with biopsy sampling.
RESULTS: In total, 1258 patients met the inclusion criteria, of whom 842 (66.9 %) underwent endoscopic follow-up. Patients were followed for a total of 2585 person-years (mean±SD 3.01 ± 2.6). Median duration until first follow-up endoscopy was 1.2 years (interquartile range 0.3 - 1.8 years). The progression rate from IND to the combined end point of HGD or EAC was 2.0 (95 % confidence interval [CI]1.5 - 2.6) per 100 person-years and progression to EAC was 1.2 (95 %CI 0.8 - 1.6). After excluding cases with HGD or EAC within 1 year after IND diagnosis (n = 16), the progression rates were 1.4 (95 %CI 1.0 - 1.9) and 0.8 (95 %CI 0.5 - 1.2) per 100 person-years for HGD or EAC and EAC, respectively.
CONCLUSION: In this large, population-based, cohort of patients with Barrett's esophagus, the incidence rate of HGD or EAC following a diagnosis of IND was 1.4 per 100 person-years. The results demonstrate the need for additional studies to select the subgroup of IND patients with an increased risk of neoplastic progression.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.