The risk of neoplasia in patients with Barrett's esophagus indefinite for dysplasia: a multicenter cohort study

Abstract

Background and Aims: Current understanding of the risk of neoplastic progression in patients with Barrett's esophagus with indefinite dysplasia (BE-IND) stems from small retrospective and pathology registry studies. In this multicenter cohort study, we aimed to determine the incidence and prevalence of neoplasia in BE-IND.Methods: Patients with confirmed BE-IND from 2 academic centers were included if they had no previous evidence of dysplasia and underwent endoscopic follow-up (FU) of !1 year. The rate of progression to neoplasia was calculated and categorized as prevalent (progression within 1 year of FU) and incident (progression after 1 year of FU). Multivariable regression adjusted for relevant clinical features was performed to identify risk factors for progression.Results: Four hundred sixty-five patients diagnosed with BE-IND were identified between 1997 and 2017, of which 223 (48.0%) were excluded. Of the remaining 242 patients, 184 (76.0%) had no evidence of dysplasia during FU. In 23 patients (9.5%), prevalent neoplasia occurred (20 low-grade dysplasia [LGD], 2 high-grade dysplasia [HGD], 1 intramucosal cancer [IMC]), whereas 35 patients (14.5%) developed incident neoplasia ( 27LGD, 5 HGD, 3 IMC), after a median 1.5 years (interquartile range, 0.6-3.2 years). The incidence rates of any neoplasia and HGD/IMC were 3.2 and 0.6 cases/100 patient-years, respectively. BE length correlated with an increased risk of prevalent (odds ratio, 1.18 per 1 cm; 95% confidence interval, 1.02-1.38; P Z .033) and incident neoplasia (odds ratio, 1.02; 95% confidence interval, 1.00-1.03; P Z .016). Conclusion:Patients with BE-IND should be closely monitored, because nearly a quarter harbor or will shortly develop dysplasia. BE length is a clinical predictor of neoplastic progression; however, more-accurate molecular biomarkers for risk stratification are warranted. (Gastrointest Endosc 2021;94:263-70.

The utility of P53 immunohistochemistry in the diagnosis of Barrett's oesophagus with indefinite for dysplasia

“…28,29 Excess of inflammation and atypia of unclear significance are the most common reasons behind BE-IND diagnosis, followed by technical artefacts. 18,29 Although, by definition, BE-IND lacks evidence of definite dysplasia, patients with this condition carry an increased risk of dysplasia compared to NDBE. Between 10% and 25% of BE-IND patients will receive a neoplastic BE diagnosis within a year.…”

“…Between 10% and 25% of BE-IND patients will receive a neoplastic BE diagnosis within a year. 18,30,31 Even though most BE-IND patients will be reclassified to NDBE at follow-up endoscopy, they remain at risk of incident neoplasia at long-term FU. A recent meta-analysis estimated the risk of incident HGD/EAC at approximately 1.5 per 100 person-years, with a pooled incidence rate of LGD of 11.4 per 100 person-years.…”

“…A diagnosis of BE‐IND is frequently encountered in clinical practice and represents between 3.6% and 8.4% of all BE diagnoses 28,29 . Excess of inflammation and atypia of unclear significance are the most common reasons behind BE‐IND diagnosis, followed by technical artefacts 18,29 . Although, by definition, BE‐IND lacks evidence of definite dysplasia, patients with this condition carry an increased risk of dysplasia compared to NDBE.…”

“…Although, by definition, BE‐IND lacks evidence of definite dysplasia, patients with this condition carry an increased risk of dysplasia compared to NDBE. Between 10% and 25% of BE‐IND patients will receive a neoplastic BE diagnosis within a year 18,30,31 . Even though most BE‐IND patients will be reclassified to NDBE at follow‐up endoscopy, they remain at risk of incident neoplasia at long‐term FU.…”

“…However, the IOA for BE‐IND is poor and overall lower than that of LGD 15,16 . This is partly because cellular atypia may be present within the background of excess inflammation 17 or technical artefact 18 . Therefore, diagnostic adjuncts are required to improve the reliability of this diagnosis.…”