Risk of Progression in Barrett’s Esophagus Indefinite for Dysplasia: A Systematic Review and Meta-Analysis

Authors

Rajesh Krishnamoorthi, Virginia Mason Medical Center
Babu P. Mohan, University of Arizona, Tucson
Mahendran Jayaraj, University of Nevada, Las VegasFollow
Kenneth K. Wang, Mayo Clinic
David A. Katzka, Mayo Clinic
Andrew Ross, Virginia Mason Medical Center
Douglas G. Adler, University of Utah School of Medicine
Prasad G. Iyer, Mayo Clinic

Document Type

Article

Publication Date

8-14-2019

Publication Title

Gastrointestinal Endoscopy

First page number:

1

Last page number:

11

Abstract

Background and Aims: Risk of progression in Barrett's esophagus (BE) with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) has been established. However, the natural history of BE with indefinite dysplasia (BE-IND) remains unclear. We performed a systematic review and meta-analysis to estimate the pooled risk of progression to HGD and/or esophageal adenocarcinoma (EAC) in BE-IND. Methods: We performed a systematic search of multiple databases to June 2018 to identify studies reporting the incidence of HGD, EAC, or HGD/EAC as an outcome in patients with BE-IND undergoing endoscopic surveillance. The pooled incidence rate of HGD and/or EAC and EAC alone was estimated. Results: We identified 8 studies reporting the incidence of HGD and/or EAC and 5 studies reporting the incidence of EAC in BE-IND. The pooled incidence of HGD and/or EAC (89 cases in 1441 patients over 5306.2 person-years) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0). The pooled incidence of EAC (40 cases in 1266 patients over 4520.2 person-years) was 0.6 per 100 person-years (95% CI, 0.1-1.1). Substantial heterogeneity was noted in the analyses. On subgroup analysis, the incidence of EAC was higher in studies from Europe compared with North America (0.9% vs 0.1%, P = .01). The pooled incidence of LGD was 11.4 per 100 person-years (95% CI, 0.06-0.2). Conclusion: The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance.

Disciplines

Digestive System Diseases | Medical Sciences

Language

English

Repository Citation

Krishnamoorthi, R., Mohan, B. P., Jayaraj, M., Wang, K. K., Katzka, D. A., Ross, A., Adler, D. G., Iyer, P. G. (2019). Risk of Progression in Barrett’s Esophagus Indefinite for Dysplasia: A Systematic Review and Meta-Analysis. Gastrointestinal Endoscopy 1-11.
http://dx.doi.org/10.1016/j.gie.2019.07.037