Endoscopic Expert Revision of Previous Histological Confirmed Flat Low-Grade Dysplasia In Barrett’s Esophagus

Aims The strongest histologic predictor for progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE) is expert confirmed diagnosis of low-grade dysplasia (LGD). Therefore, Dutch guidelines advise to refer patients with confirmed LGD to a Barrett’s Expert Center (BEC). Aim was to assess if a community finding of confirmed LGD in BE without visible lesions (VL), is an indicator for higher grades of dysplasia.

Methods Endoscopic therapy for BE neoplasia in NL is centralized in 9 BECs with trained endoscopists and pathologists. Upon community hospital LGD diagnosis, a expert pathology panel reviews biopsies. If LGD is confirmed, patients are referred for imaging endoscopy, followed by target/Seattle biopsies, in a BEC <3 months. We collected data from patients with confirmed LGD in random biopsies, without VL, referred between Jan 2017-Oct 2019, since the guideline was introduced in 2017. Primary outcome was worst baseline histology in the BEC, reviewed by an expert pathologist.

Results

Histopathology in BEC	Total cohort (n = 222)	No visible lesion detected in BEC (n = 166)	Visible lesion detected in BEC (n = 56)
NDBE, n (%); [95 %CI]	21 (10); [6-14]	20 (12); [8-18]	1 (2); [0-10]
Second confirmation LGD, n (%); [95 %CI]	147 (66); [60-72]	135 (81); [75-87]	12 (21); [12-34]
HGD, n (%); [95 %CI]	30 (13); [9-19]	11 (7); [3-12]	19 (34); [22-48]
EAC, n (%); [95 %CI]	24 (11); [7-16]	–	24 (43); [30-58]

222 patients with confirmed LGD without VL were referred to a BEC. Time to BEC endoscopy was 3mo (IQR 0-3). In 54/222 patients (24 %;95 %CI 19-31), higher grade of neoplasia was found (HGD n = 30; EAC n = 24). The majority of these patients (43; 80 %) had a VL, 11 (20 %) had HGD in random biopsies. 53/54 patients (98 %) had curative endoscopic treatment, one (2 %) had deep submucosal invasion and required esophagectomy. LGD was reconfirmed in 147 patients (66 %; 95 %CI 60-72). The majority of LGD patients received endoscopic treatment (125/147;85 %) of which 119 (95 %) achieved complete eradication.

Conclusions After expert panel LGD confirmation in BE without VL diagnosed in a community hospital, dysplasia was reproduced in >90 % upon BEC endoscopy. In 24 % of patients, higher grades of dysplasia were found. Our results endorse the current advice to confirm LGD, and to refer patients with confirmed LGD to an expert center.

Citation: Nieuwenhuis EA, van Munster SN, Weusten BLAM et al. ḤOP73 ENDOSCOPIC EXPERT REVISION OF PREVIOUS HISTOLOGICAL CONFIRMED FLAT LOW-GRADE DYSPLASIA IN BARRETT’S ESOPHAGUS. Endoscopy 2021; 53: S30.

Publication History

Article published online:
19 March 2021