Predictors of dysplastic and neoplastic progression of Barrett's esophagus

Abstract

Background: It is unknown why some cases of Barrett's esophagus progress to invasive malignant disease rapidly while others do so more slowly or not at all. The aim of this study was to identify demographic and endoscopic factors that predict dysplastic and neoplastic progression in patients with Barrett's esophagus. Methods: Patients with Barrett's esophagus who were assessed in 2000-2010 were assessed for inclusion in this retrospective study. Demographic and endoscopic variables were collected from an endoscopy database and the medical chart. Dysplastic and neoplastic progression was examined by time-to-event analysis. We used Cox proportional hazard regression modelling and generalized estimating equation methods to identify variables that were most predictive of neoplastic progression. Results: A total of 518 patients had Barrett's esophagus confrmed by endoscopy and pathology and at least 2 surveillance visits. Longer Barrett's esophagus segment (= 3 cm) (odds ratio [OR] 1.2, 95% confdence interval [CI] 1.1-1.3) and increased age (= 60 yr) (OR 3.5, 95% CI 1.7-7.4) were independent predictors of progression from nondysplasia to dysplastic or neoplastic grades. Presence of mucosal irregularities (OR 8.6, 95% CI 2.4-30.4) and increased age (OR 5.1, 95% CI 1.6-16.6) were independent predictors of progression from nondysplasia to high-grade dysplasia or adenocarcinoma. Conclusion: Increased age, longer Barrett's segment and presence of mucosal irregularities were associated with increased risk of dysplastic and neoplastic progression. In addition to dysplasia, these factors may help stratify patients according to risk of neoplastic progression and be used to individualize surveillance. More prospective studies with larger samples are required to validate these results.