Barrett's Esophagus and Adenocarcinoma Risk The Experience of the North-Eastern Italian Registry (EBRA)

Departments of *Pathology and †Surgery, University of Padova, Padova ‡Department of Pathology, Casa Sollievo della Sofferenza, S. Giovanni Rotondo §Veneto Institute of Oncology [IOV-IRCCS], Padova ‖Department of Gastroenterology and Pathology, Belluno Hospital, Belluno ¶Departments of Gastroenterology and Pathology, Dolo Hospital, Dolo, Venice #Department of Gastroenterology and Pathology, Feltre Hospital, Feltre **Departments of Gastroenterology and Pathology, Negrar Hospital, Negrar, Verona ††Departments of Gastroenterology and Pathology, Rovereto Hospital, Rovereto ‡‡Departments of Gastroenterology and Pathology, S. Chiara Hospital, Trento §§Departments of Gastroenterology and Pathology, S. Bortolo Hospital, Vicenza ‖‖Departments of Surgery and Pathology, S. Donà Hospital, Venice ¶¶Departments of Gastroenterology and Pathology, Cà Foncello Hospital, Treviso ##Departments of Surgery-Gastroenterology and Pathology, University of Padova Hospital, Padova ***Department of Gastroenterology, S. Antonio Hospital, Padova †††Departments of Gastroenterology and Pathology, Bassano Hospital, Bassano
Annals of surgery (Impact Factor: 8.33). 11/2012; 256(5):788-795. DOI: 10.1097/SLA.0b013e3182737a7e
Source: PubMed


OBJECTIVE:: To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. BACKGROUND:: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. METHODS:: In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression. RESULTS:: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. CONCLUSIONS:: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

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