Faculty Collaboration Database

Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study. Endoscopy 2015 Aug;47(8):669-74

Date

04/25/2015

Pubmed ID

25910065

DOI

10.1055/s-0034-1391966

Scopus ID

2-s2.0-84938294126 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

BACKGROUND AND STUDY AIM: Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy.

PATIENTS AND METHODS: Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated.

RESULTS: Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar.

CONCLUSIONS: Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.

Author List

Sinh P, Anaparthy R, Young PE, Gaddam S, Thota P, Balasubramanian G, Singh M, Higbee AD, Wani S, Gupta N, Rastogi A, Mathur SC, Bansal A, Horwhat JD, Cash BD, Falk GW, Lieberman DA, Vargo JJ, Sampliner RE, Sharma P

Authors

Gokulakrishnan Balasubramanian MD Associate Professor in the Medicine department at Medical College of Wisconsin
Preetika Sinh MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Barrett Esophagus
Deglutition Disorders
Disease Progression
Endoscopy, Gastrointestinal
Esophagus
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Precancerous Conditions
Time Factors
United States