Endoscopy. 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.

Sinh P1, Anaparthy R1, Young PE2, Gaddam S3, Thota P4, Balasubramanian G1, Singh M1, Higbee AD1, Wani S5, Gupta N6, Rastogi A1, Mathur SC7, Bansal A1,Horwhat JD8, Cash BD2, Falk GW4, Lieberman DA9, Vargo JJ4, Sampliner RE10, Sharma P1.

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.