Clinical Question: Which men with B...

Clinical Question: Which men with Barrett's esophagus are at greatest risk of progression to high-grade dysplasia or cancer?

Setting: Outpatient (specialty)

subject of attention Design: Cohort (prospective)

Synopsis: The authors identified 550 patients who underwent endoscopy for any reason and were diagnosed with Barrett's esophagus between 1990 and 2003 The reflection took place at a Veterans Affairs hospital, 99 percent of participants were men and 93 percent were white. Patients ranged in age from 28 to 86 years (mean age = 63 years). At the initial endoscopy, 77 percent had no dysplasia, 18 percent had low-grade dysplasia, and 5 percent had unifocal high-grade dysplasia. Helicobacter pylori infection was absent in 345 patients, current in 72 patients, and a history of H pylori eradication was identified in 60 patients. Patients with cancer, dysplasia-associated lesion or mass, or intramucosal cancer at enrollment were exclud (n = 28)

Of the 550 patients initially identified, 28 had a diagnosis of malignancy, 173 had no follow-up endoscopy, 15 died from other causes, and 10 were missing to follow-up, leaving 324 for the close attention It is unknown whether consequences were assessed blindly. Patients with newly diagnosed low-grade dysplasia or unifocal high-grade dysplasia had optimized medical therapy and were re-endoscoped at 12 to 24 weeks (for patients with low-grade dysplasia) or four to eight weeks (for patients with high-grade dysplasia). Patients with persistent high-grade dysplasia had surveillance at three- to six-month intervals, while those with low-grade dysplasia or regression to normal had surveillance at six- to 12-month intervals. Although patients were followed for up to 130 month based forward the Kaplan-Meier curves, the mean or median duration of follow-up or the number of follow-up endoscopies was not given.

proceeds were presented in several ways. Independent risk factors for high-grade dysplasia or cancer at the initial endoscopy were increased age, greater amplification of Barrett's esophagus (especially greater than 6 cm) and not at any time having been diagnosed with H pylori infection. The independent risk factors for progression of Barrett's esophagus to high-grade dysplasia or cancer were duration initial histology, histology at follow-up and H pylori status. The risk was grave for patients with no dysplasia in succession the initial endoscopy (i.e., 24 percent if the long duration is less than 6 cm; 68 percent if the detail is more than 6 cm) or with low-grade dysplasia and nothing else (i.e., 5.3 percent with longitudinal dimensions of less than 6 cm) All other assemblages had at least a 35 percent risk of progression.

Bottom Line: Patients with no dysplasia forward the initial endoscopy or with low-grade dysplasia solely and Barrett's esophagus length of les than 6 cm have a actual low risk of progression to high-grade dysplasia or malignancy. (Level of Evidence: 2b)

thought Reference: Weston AP, et al. Risk stratification of Barrett's esophagus: updated prospective multivariate analysis. Am J Gastroenterol September 2004;99:1657-66

Used with permission from Ebell M extent and dysplasia predict BE progression in men Accessed online November 24 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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