Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia: A nationwide cohort study

Christine Kestens, Max Leenders, G. Johan A Offerhaus, Jantine W P M Van Baal, Peter D. Siersema

Research output: Contribution to journalArticle

Abstract

Background and study aims: A histological diagnosis of indefinite for dysplasia (IND) in Barrett's esophagus is used when a diagnosis of genuine dysplasia is equivocal. The aim of the present study was to assess the risk of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) after a diagnosis of IND in a nationwide cohort of patients with Barrett's esophagus. Patients and methods: Patients with a first diagnosis of IND in Barrett's esophagus between 2002 and 2011 were selected from a nationwide registry of histopathology diagnoses in The Netherlands. Patients were followed up until treatment for HGD, detection of EAC, or date of last endoscopy contact with biopsy sampling. Results: In total, 1258 patients met the inclusion criteria, of whom 842 (66.9%) underwent endoscopic follow-up. Patients were followed for a total of 2585 person-years (mean ± SD 3.01 ± 2.6). Median duration until first follow-up endoscopy was 1.2 years (interquartile range 0.3a-1.8 years). The progression rate from IND to the combined end point of HGD or EAC was 2.0 (95% confidence interval [CI] 1.5-2.6) per 100 person-years and progression to EAC was 1.2 (95%CI 0.8-1.6). After excluding cases with HGD or EAC within 1 year after IND diagnosis (na=16), the progression rates were 1.4 (95%CI 1.01.9) and 0.8 (95%CI 0.5-1.2) per 100 person-years for HGD or EAC and EAC, respectively. Conclusion: In this large, population-based, cohort of patients with Barrett's esophagus, the incidence rate of HGD or EAC following a diagnosis of IND was 1.4 per 100 person-years. The results demonstrate the need for additional studies to select the subgroup of IND patients with an increased risk of neoplastic progression.

Original languageEnglish (US)
Pages (from-to)409-414
Number of pages6
JournalEndoscopy
Volume47
Issue number5
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Barrett Esophagus
Adenocarcinoma
Cohort Studies
Confidence Intervals
Endoscopy
Netherlands
Registries
Biopsy
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Kestens, C., Leenders, M., Offerhaus, G. J. A., Van Baal, J. W. P. M., & Siersema, P. D. (2015). Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia: A nationwide cohort study. Endoscopy, 47(5), 409-414. https://doi.org/10.1055/s-0034-1391091

Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia : A nationwide cohort study. / Kestens, Christine; Leenders, Max; Offerhaus, G. Johan A; Van Baal, Jantine W P M; Siersema, Peter D.

In: Endoscopy, Vol. 47, No. 5, 01.05.2015, p. 409-414.

Research output: Contribution to journalArticle

Kestens, C, Leenders, M, Offerhaus, GJA, Van Baal, JWPM & Siersema, PD 2015, 'Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia: A nationwide cohort study', Endoscopy, vol. 47, no. 5, pp. 409-414. https://doi.org/10.1055/s-0034-1391091
Kestens, Christine ; Leenders, Max ; Offerhaus, G. Johan A ; Van Baal, Jantine W P M ; Siersema, Peter D. / Risk of neoplastic progression in Barrett's esophagus diagnosed as indefinite for dysplasia : A nationwide cohort study. In: Endoscopy. 2015 ; Vol. 47, No. 5. pp. 409-414.
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abstract = "Background and study aims: A histological diagnosis of indefinite for dysplasia (IND) in Barrett's esophagus is used when a diagnosis of genuine dysplasia is equivocal. The aim of the present study was to assess the risk of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) after a diagnosis of IND in a nationwide cohort of patients with Barrett's esophagus. Patients and methods: Patients with a first diagnosis of IND in Barrett's esophagus between 2002 and 2011 were selected from a nationwide registry of histopathology diagnoses in The Netherlands. Patients were followed up until treatment for HGD, detection of EAC, or date of last endoscopy contact with biopsy sampling. Results: In total, 1258 patients met the inclusion criteria, of whom 842 (66.9{\%}) underwent endoscopic follow-up. Patients were followed for a total of 2585 person-years (mean ± SD 3.01 ± 2.6). Median duration until first follow-up endoscopy was 1.2 years (interquartile range 0.3a-1.8 years). The progression rate from IND to the combined end point of HGD or EAC was 2.0 (95{\%} confidence interval [CI] 1.5-2.6) per 100 person-years and progression to EAC was 1.2 (95{\%}CI 0.8-1.6). After excluding cases with HGD or EAC within 1 year after IND diagnosis (na=16), the progression rates were 1.4 (95{\%}CI 1.01.9) and 0.8 (95{\%}CI 0.5-1.2) per 100 person-years for HGD or EAC and EAC, respectively. Conclusion: In this large, population-based, cohort of patients with Barrett's esophagus, the incidence rate of HGD or EAC following a diagnosis of IND was 1.4 per 100 person-years. The results demonstrate the need for additional studies to select the subgroup of IND patients with an increased risk of neoplastic progression.",
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AU - Siersema, Peter D.

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