Patients with stable Barrett's esophagus may need less surveillance, study finds

The results could influence the number of endoscopies performed or extend the time between them, the authors noted.

Patients with stable nondysplastic Barrett's esophagus (NDBE) have a low risk of progression to high-grade dysplasia or esophageal adenocarcinoma, according to a population-based study in the Netherlands.

Researchers assessed cancer risk based on the subsequent number of endoscopies showing persistence of NDBE among 12,728 patients with a first diagnosis from 2003 to 2013 selected from the Dutch nationwide registry of histopathology. Patients were included in five individual overlapping cohorts according to the number of consecutive endoscopies that showed NDBE. Persistent NDBE was defined as NDBE on at least two consecutive endoscopies (initial NDBE diagnosis and the first follow-up diagnosis). Study results were published Sept. 10 by Clinical Gastroenterology and Hepatology.

High-grade dysplasia or esophageal adenocarcinoma developed in 436 patients (3.4%) during 64,537 person-years of follow up. The rate of progression to high-grade dysplasia or esophageal adenocarcinoma was 0.68 (95% CI, 0.61 to 0.74) per 100 person-years, according to the study. In patients with two consecutive endoscopies showing NDBE, the rate of progression to high-grade dysplasia or esophageal adenocarcinoma decreased to 0.55 (95% CI, 0.46 to 0.64) per 100 person-years (incidence rate ratio [IRR], 0.72; 95% CI, 0.60 to 0.87). Incidence of high-grade dysplasia or esophageal adenocarcinoma decreased by 14% for each year of progression-free follow-up (IRR, 0.86; 95% CI, 0.81 to 0.92).

The authors wrote that surveillance intervals might be lengthened or surveillance might even be discontinued in patients with persistent yet stable NDBE. The absolute risk of malignant progression in patients with NDBE is less than one-half of a percent annually, they said.

“When surveillance is continued after 3 negative endoscopies, 57 patients will undergo unnecessary surveillance endoscopies to detect 1 patient with [high-grade dysplasia]/[esophageal adenocarcinoma],” the authors wrote. “Hence, results from our study imply that in patients with multiple negative endoscopies harms and costs may outweigh the potential benefits of a surveillance program. Surveillance may be discontinued at an earlier endpoint than currently recommended, in particular in patients with life-limiting comorbidity.”