Saturday, April 25, 2015

Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study

 2015 Apr 24. [Epub ahead of print]

Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study.

Author information

  • 1Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
  • 2Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
  • 3Department of Gastroenterology, Washington University in St. Louis, St Louis, Missouri, USA.
  • 4Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
  • 5Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
  • 6Division of Gastroenterology, Loyola University, Maywood, Illinois, USA.
  • 7Department of Pathology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
  • 8Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
  • 9Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon, USA.
  • 10Department of Pathology, University of Arizona Cancer Center, Tucson, Arizona, USA.

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.

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