Background and study aims: Surveillance in Barrett's esophagus relies on the detection of dysplasia by histopathology.
However, the natural history of this condition, particularly that of low-grade dysplasia
(LGD) is poorly understood. This paper describes our experience of LGD over a period
of 21 years.
Patients and methods: Between 1984 and January 1995, 357 patients with Barrett's esophagus without dysplasia
were recruited for annual surveillance: 34 of these patients developed LGD during
this period. This was a retrospective cohort study of this group in terms of survival
and cancer outcomes ≥ 8 years after the original diagnosis of LGD, comparing them
with the patients who did not develop LGD over the same period, with a histopathological
review of the original diagnoses of LGD. The outcomes of 356/357 (99.7 %) of the patients
were established in December 2004.
Results: After 8 years, high-grade dysplasia (HGD) or cancer had developed in 9/34 patients
with LGD (27 %) and in 16/322 controls (5 %). Cox’s proportional hazards model revealed
that the time from the first diagnosis of Barrett's esophagus to the first “event”
of either HGD, esophageal cancer, or death did not show a statistically significant
difference between the two groups. A further analysis treating death as “loss to follow-up”
showed a significantly increased risk for the LGD group to progress to HGD or cancer
(hazard ratio 5.9 [95 % confidence interval 2.6 - 13.4], P< 0.001). The histopathology review demonstrated a fair level of agreement between
pathologists, with a kappa value of 0.48.
Conclusions: Patients diagnosed with LGD during surveillance of Barrett's esophagus are at a considerably
increased risk of progressing to develop esophageal cancer over an 8-year period but
most deaths are not cancer-related.
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C. H. Lim, MD
Department of Gastroenterology
Good Hope Hospital
Rectory Road
Sutton Coldfield
West Midlands B75 7RR
United Kingdom
Fax: +44-121-3786095
eMail: Chee.Lim@heartofengland.nhs.uk