- Title
- Outcomes of patients with Barrett's oesophagus with low-grade dysplasia undergoing endoscopic surveillance in a tertiary centre: a retrospective cohort study
- Creator
- Vlismas, Luke J.; Potter, Michael; Loewenthal, Mark R.; Wilson, Katie; Allport, Kelleigh; Gillies, Donna; Cook, Dane; Philcox, Stephen; Bollipo, Steven; Talley, Nicholas J.
- Relation
- Internal Medicine Journal Vol. 54, Issue 11, p. 1867-1875
- Publisher Link
- http://dx.doi.org/10.1111/imj.16532
- Publisher
- John Wiley & Sons
- Resource Type
- journal article
- Date
- 2024
- Description
- Background and Aim: Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression. Methods: Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed. Results: Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3–12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9–22.8; P = 0.003). Conclusion: Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.
- Subject
- Barrett’s oesophagus; upper gastrointestinal endoscopy; low-grade dysplasia; oesophageal neoplasm; metaplasia; neoplasia
- Identifier
- http://hdl.handle.net/1959.13/1520514
- Identifier
- uon:57484
- Identifier
- ISSN:1444-0903
- Rights
- © 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
- Language
- eng
- Full Text
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