Post written by Madhav Desai, MD, MPH, from the Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Barrett’s esophagus (BE) is a known precursor lesion for esophageal adenocarcinoma (EAC), and we know that incidence of the latter is rising in last 30 years thereby necessitating early detection and management of this premalignant condition.
Recent studies have shown that a large number of patients were diagnosed with EAC within the first year of diagnosis of BE. We currently do not know if detection of dysplasia and esophageal adenocarcinoma (EAC) in BE patients undergoing index endoscopy contributes to this rise, perhaps suggesting our efforts are improving in recent years (ie, how good are we at finding prevalent cases). Our aim was to determine the prevalence patterns of BE-associated dysplasia on index endoscopy over the past 25 years.
We examined a large cohort of BE patients (multicenter registry) who underwent index endoscopy for BE exam over a span of 25 years (1990 to 2016) and analyzed outcomes for time trends over 25 years with comparisons across 5-year cohorts. A total of 3643 patients were included in the analysis with index endoscopy showing: nondysplastic BE in 70.1%, low-grade dysplasia (LGD) in 11.5%, high-grade dysplasia (HGD) in 5.4%, and EAC in 5.1% of patients.
Over time, there was an increase in the mean age of BE patients (51.7 ± 29 years vs 62.6 ± 11.3 years) and proportion of males (84 % vs 92.6%) diagnosed with BE but a decrease in the mean BE length (4.4±4.3 cm vs 2.9±3.0 cm) as time progressed (1990-1994 to 2010-2016). Presence of LGD on index endoscopy remained stable in 1990-2016. However, a significant increase (148% in HGD and 112% in EAC) in the diagnosis of HGD, EAC, and HGD/EAC was noted on index endoscopy over last 25 years (P<0.001) . There was also a significant increase in the detection of visible lesions on index endoscopy (1990-1994: 5.1% to 2005-2009: 6.3% and 2010+:16.3%) during the same time period.
Figure 1. Trend of BE-related dysplasia, visible lesions, and BE length over last 25 years on index endoscopy.
Our results suggest that the prevalence of HGD and EAC has significantly increased over the past 25 years despite a decrease in BE length during the same time period. This rise parallels an increase in the detection of visible lesions suggesting that a careful examination at the index examination is crucial.
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