Audit of a Barrett's epithelium surveillance database

K K Basu, B Pick, J S de Caestecker
European Journal of Gastroenterology & Hepatology 2004, 16 (2): 171-5

BACKGROUND: Barrett's epithelium is a premalignant condition in which endoscopic surveillance is recommended but remains contentious.

AIM: To audit our Barrett's epithelium surveillance database and to calculate the incidence and natural history of dysplasia and cancer in this cohort.

METHODS: A retrospective analysis of a computerised database of patients with columnar lined oesophagus containing specialised intestinal metaplasia was undertaken over a 5-year period. The surveillance protocol was annual endoscopy with 2-cm interval quadrantic biopsies with patients on continuous acid-suppression therapy.

RESULTS: A total of 138 (102 men) patients underwent active surveillance. The mean age was 62.1 years and the mean Barrett's epithelium length was 5.9 cm. Ten patients had low-grade dysplasia, with a mean age of 73.5 years, a mean Barrett's epithelium length of 7.8 cm, a prevalence of 7.2% over 5 years and an incidence of 1.4% per annum. Low-grade dysplasia regressed in five patients, persisted in four patients, and was associated with a concurrent squamous carcinoma in one patient. Three patients had high-grade dysplasia at index endoscopy, with no incident cases. One progressed to adenocarcinoma after 2 years. A cancer incidence of one per 202 patient-years of surveillance was found, equivalent to 0.5% per year.

CONCLUSION: Short-interval (1-year) endoscopic surveillance of Barrett's epithelium offers little reward. Low-grade dysplasia is uncommon, and no progression to adenocarcinoma was seen in this cohort. No incident high-grade dysplasia was observed. Prospective evaluation of a longer endoscopic surveillance interval in controlled clinical studies is warranted.

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