Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Viveksandeep Thoguluva Chandrasekar; Nour Hamade; Madhav Desai; Tarun Rai; Venkata Subhash Gorrepati; Ramprasad Jegadeesan; Anjana Sathyamurthy; Prateek Sharma

doi:10.1055/a-0869-7960

Endoscopy, Table of Contents

Endoscopy 2019; 51(07): 665-672
DOI: 10.1055/a-0869-7960

Review

Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett’s esophagus: a systematic review and meta-analysis

Viveksandeep Thoguluva Chandrasekar

¹Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Nour Hamade

²Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Madhav Desai

¹Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Tarun Rai

³Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA

,

Venkata Subhash Gorrepati

⁴Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA

,

Ramprasad Jegadeesan

¹Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Anjana Sathyamurthy

³Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA

,

Prateek Sharma

³Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA

› Author Affiliations

Abstract

Background Although shorter lengths of Barrett’s esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length.

Methods PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated.

Results Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % – 0.10 %) vs. 0.31 % (0.21 % – 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 – 0.56); P < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % – 0.32 %) vs. 0.76 % (0.43 % – 0.89 %), respectively; OR 0.35 (0.21 – 0.58); P < 0.001. There was no significant heterogeneity among studies.

Conclusion The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.

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References

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