Increasing prevalence of high-grade dysplasia and adenocarcinoma on index endoscopy in Barrett's esophagus over the past 2 decades: data from a multicenter U.S. consortium.

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Barrett’s Esophagus; Esophageal adenocarcinoma; Prevalence


INTRODUCTION: Data on time trends of dysplasia and esophageal adenocarcinoma (EAC) in Barrett's esophagus (BE) during the index endoscopy (ie, prevalent cases) are limited. Our aim was to determine the prevalence patterns of BE associated dysplasia on index endoscopy over the past 25 years.

METHODS: The Barrett's esophagus study is a multicenter outcome project of a large cohort of BE patients. Proportion of patients with index endoscopy findings of no dysplasia (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and esophageal adenocarcinoma (EAC) were extracted per year of index endoscopy, and 5-yearly patient cohorts were tabulated over years 1990 to 2010+ (2010-current). Prevalent dysplasia and endoscopic findings were trended over the past 25 years using percentage dysplasia (LGD, HGD, EAC, and HGD/EAC) to assess changes in detection of BE associated dysplasia over the last 25 years. Statistical analysis was done using software SAS version 9.4 (Cary, NC).

RESULTS: A total of 3643 patients were included in the analysis with index endoscopy showing: NDBE in 2513 (70.1%), LGD in 412 (11.5%), HGD in 193 (5.4%), and EAC in 181 (5.1%). Over time, there was an increase in the mean age of BE patients (51.7 ± 29 years vs 62.6 ± 11.3 years) and proportion of males (84 % vs 92.6%) diagnosed with BE but a decrease in the mean BE length (4.4±4.3 cm vs 2.9±3.0 cm) as time progressed (1990-1994 to 2010-2016 time periods). Presence of LGD on index endoscopy remained stable over years 1990 to 2016. However, a significant increase (148% in HGD and 112% in EAC) in the diagnosis of HGD, EAC, and HGD/EAC were noted on index endoscopy over last 25 years (p

CONCLUSION: Our results suggest that the prevalence of HGD and EAC has significantly increased over the past 25 years despite a decrease in BE length during the same period. This rise parallels an increase in the detection of visible lesions, suggesting that a careful examination at the index examination is crucial.

Clinical Institute

Digestive Health