Thomas Jefferson University Hospital Philadelphia, PA
Daniel F. Garrido, MD, Christina Tofani, MD, Anthony Infantolino, MD, FACG; Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Barrett’s esophagus (BE) is a premalignant condition with increased risk for progression to esophageal adenocarcinoma (EAC). Certain factors influence progression to EAC including the length of BE segment and degree of dysplasia. Although prior studies have assessed risk of progression from non-dysplastic BE (NDBE) to high-grade dysplasia (HGD) or EAC, limited studies assess risk to low-grade dysplasia (LGD). This study aimed to identify the correlation between patients with NDBE segment length and the development of indefinite dysplasia (IND)/LGD or HGD/EAC. Methods: A retrospective medical record review was performed of patients with BE at a single tertiary medical center. Inclusion criteria were patients determined to have NDBE at initial endoscopy and had at least 1-year follow-up. Patients were stratified into the following groups based on segment length of NDBE: 0-2cm, 3-5cm, and 6-20cm. The primary endpoints of this study were the progression to either IND/LGD or to HGD/EAC from NDBE. A competing risks model was utilized for both Kaplan-Meier and proportional hazards regression analysis. This study was approved by the Institutional Review Board. Results: A total of 106 patients met inclusion criteria for this study. Ultimately, 33 patients progressed to IND/LGD with 11 progressing from BE segment length ≥6cm. Additionally, 53 patients progressed to HGD/EAC with 24 progressing from BE segment length ≥6cm. A BE segment length ≥6cm was associated with lower risk of progression from NDBE to IND/LGD with a hazard ratio (HR) of 0.32 (95% CI: 0.13-0.79, p=0.01) (Table 1.), whereas BE segment length ≥6cm was associated with increasing risk of progression from NDBE to HGD/EAC with a HR = 2.68 (95% CI: 1.01-7.09, p=0.02) (Table 2.). BMI ≥30 was also found to be associated with increased risk of progression to HGD/EAC with a HR of 2.11 (95% CI: 1.03-4.31, p=0.041), along with age ≥70 years with a HR of 5.21 (95% CI: 1.61-16.91, p=0.006). Discussion: Although risk of progression to HGD/EAC was increased in BE segment length ≥6cm, longer segments were associated with decreased risk of progression to IND/LGD. Results may be influenced by whether there was proper utilization of the Seattle protocol when performing surveillance endoscopy or by interobserver variability in pathology. However, we postulate these results raise questions whether appropriate risk factors are assessed in determining progression to IND/LGD. Future studies may investigate other potential risks to progression for IND/LGD.
Table 1. Hazard ratios associated with the risk of developing LGD/IND
Table 2. Hazard ratios associated with the risk of developing HGD/EAC
Disclosures: Daniel Garrido indicated no relevant financial relationships. Christina Tofani indicated no relevant financial relationships. Anthony Infantolino indicated no relevant financial relationships.