Dysplasia detection rate of confirmatory EGD in nondysplastic Barrett's esophagus

Abstract

Current guidelines for endoscopic surveillance of Barrett's esophagus (BE) recommend that patients with newly diagnosed BE undergo confirmatory esophagogastroduodenoscopy (EGD) to exclude the presence of dysplasia. The extent to which confirmatory endoscopy alters management and detects missed dysplasia in newly diagnosed BE has not been reported. The frequency with which confirmatory endoscopy changed surveillance management in patients with newly diagnosed BE was assessed. A two center cohort analysis was conducted on patients newly diagnosed with BE. The rate of dysplasia on confirmatory endoscopy for patients who had nondysplastic BE was obtained. Demographic and endoscopic variables were assessed for association with dysplasia detection using Firth logistic regression model. Out of the 146 patients newly diagnosed with BE and initially determined to be without dysplasia, 12 had dysplasia on the confirmatory second EGD (8.2%). Eleven of 12 cases with dysplasia on confirmatory endoscopy had long-segment BE (LSBE). Among all the LSBE cases in our cohort, 11 had newly diagnosed dysplasia on confirmatory EGD, 29.7% (11/37). The average number of biopsies obtained from the 11 LSBE cases with dysplasia was comparable with the rest of the LSBE cases without dysplasia (6.73 and 5.42, respectively, P-value 0.205). The rate of dysplasia detection in short-segment BE (SSBE) was much lower, 0.95% (1 out of 105). There were no cases of high-grade dysplasia (HGD) or cancer detected in any SSBE case. HGD was detected on confirmatory EGD in two cases, both were LSBE. Segment length was the only statistically significant factor to predict the presence of dysplasia on confirmatory endoscopy (odds ratio 9.158, P. 0.008). Confirmatory EGD in newly diagnosed LSBE had significant rate of dysplasia detection (29.7%) in this cohort. Among patients with SSBE, there was a low rate of dysplasia detection with confirmatory EGD, less than 1% of cases. No additional cases of HGD or esophageal carcinoma in SSBE cases were detected. This suggests that the yield of confirmatory EGD is greater in patients with LSBE.

BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

“…In cases of persistence (i.e., LGD present at a second, confirmatory endoscopy) (136), there is evidence to suggest that these patients may be at higher risk, as the “SURF” study (30) demonstrated that persistence of LGD over time in the control group was predictive of progression. In such patients, the risks and benefits of therapy need to be carefully evaluated.…”

“…Similarly, the patient phenotypic characteristics of LGD in BE (e.g., focal vs. multifo-cal, short segment vs. long segment, persistent over time vs. intermittent (i.e., found at a second confirmatory endoscopy (136) at a surveillance interval of 6–12 months), consensus pathological agreement, and so on) have variably been described as important in predicting progression (29), while Wani et al (52) followed up more than 200 patients with BE and LGD for >6 years (mean) and found that none of these variables predicted histological progression. There are several studies that indicate that patients with persistent, multifocal LGD in a longer segment of BE are more likely to progress to EA (131,136) and Thota et al (138) found a correlation between multifocality of LGD and progression of neoplasia (EA) in a single-center experience of over 1,500 patient-years and a 6% decreased likelihood of dysplastic regression per 1 cm increase in BE length. Moreover, recently, Phoa et al (30) in a large RCT demonstrated that persistence of LGD over time and length of BE was predictive of progression in the control group.…”

Yield of Repeat Endoscopy in Barrett’s Esophagus with No Dysplasia and Low-Grade Dysplasia: A Population-Based Study

“…Abdalla and colleagues reported this association in their cohort of missed dysplasias as well. [18] Other studies have found that adherence to biopsy protocol decreases in patients with longer BE, resulting in a lower detection rate of dysplasia/EAC. [2,3] Although our overall rate of adherence was poor (41%), adherence did not significantly differ between the groups with and without missed dysplasia/EAC, raising the question of sampling error.…”

The Presence of Genetic Mutations at Key Loci Predicts Progression to Esophageal Adenocarcinoma in Barrett’s Esophagus

“…Consequently, incidence of EAC is increased in BE with high-grade dysplasia (HGD) compared with nondysplastic BE (NDBE) (5, 6). Currently, dysplasia is the only clinical biomarker that is commonly used to stratify risk in BE (7, 8, 9). Patients with BE undergo periodic endoscopic surveillance to detect dysplasia and adenocarcinoma, but it is unclear whether this practice is beneficial (10, 11, 12).…”