Support for Continued Surveillance of Nondysplastic Barrett Esophagus

Summary and Comment |
March 20, 2017

Support for Continued Surveillance of Nondysplastic Barrett Esophagus

  1. David A. Johnson, MD

In two studies, risk for progression to dysplasia did not decrease with successive negative endoscopies.

  1. David A. Johnson, MD

Studies estimating risk for histologic progression from nondysplastic Barrett esophagus (NDBE) that is persistently evident on sequential exams show mixed results. While some indicate a lower risk for progression, and therefore less need for regular surveillance in these patients, others conversely report increased risk over time.

In two retrospective cohort studies of patients with index exams showing NDBE, investigators assessed risk for histologic progression. In the first study, researchers at a single center followed 480 patients for an average of 3.8 years and found an overall annual rate of progression to dysplasia of 0.87% and to esophageal adenocarcinoma (EAC) of 0.11%. They found no association between the number of consecutive surveillance endoscopies showing NDBE and risk for progression to dysplasia or EAC.

In the second study, a 5-year follow-up of 28,561 male veteran patients, the annual EAC incidence rate increased with each successive negative surveillance endoscopy (rate ratio per each additional endoscopy, 1.4) and was nine times higher at the fifth follow-up compared with the first.

Comment

The most recent American College of Gastroenterology guideline recommends that patients with NDBE should have a repeat exam 3 to 5 years after the index exam. These two studies highlight that continued surveillance is warranted, even after sequential biopsies show no dysplastic changes. Additionally, previously reported risks for progression with increasing age, male gender, and being overweight were not evident in these analyses. Until we have discriminant predictors for nonprogressive histologic change, continued regular endoscopic surveillance is recommended.

Note to readers: At the time NEJM Journal Watch reviewed the paper by Krishnamoorthi R et al., its publisher noted that it was not in final form and that subsequent changes might be made.

Editor Disclosures at Time of Publication

  • Disclosures for David A. Johnson, MD at time of publication Consultant / Advisory board Medscape; Pfizer; CRH Medical Corporation; American Board of Internal Medicine; WebMD Equity CRH Medical Corporation Editorial boards Medscape Gastroenterology Leadership positions in professional societies American Board of Internal Medicine (Gastroenterology Examination Board)

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