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

Authors

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

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

References
1 Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol 1999; 26: 2-8
2 Vizcaino AP, Moreno V, Lambert R. et al. Time trends incidence of both major histologic types of esophageal carcinomas in selected countries, 1973–1995. Int J Cancer 2002; 99: 860-868
3 Botterweck AA, Schouten LJ, Volovics A. et al. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol 2000; 29: 645-654
4 Lord RV, Law MG, Ward RL. et al. Rising incidence of oesophageal adenocarcinoma in men in Australia. J Gastroenterol Hepatol 1998; 13: 356-362
5 Howlader N, Noone AM, Krapcho M. et al. eds. SEER Cancer Statistics Review, 1975–2014. (based on November 2016 SEER data submission, posted to the SEER website, April 2017) National Cancer Institute, Bethesda, MD. Available from: https://seer.cancer.gov/csr/1975_2014/ (Accessed: 1 March 2019)
6 Hvid-Jensen F, Pedersen L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. NEJM 2011; 365: 1375-1383
7 Kastelein F, van Olphen S, Steyerberg EW. et al. ProBarstudy group. Surveillance in patients with long-segment Barrett’s oesophagus: a cost-effectiveness analysis. Gut 2015; 64: 864-871
8 Inadomi JM, Sampliner R, Lagergren J. et al. Screening and surveillance for Barrett esophagus in high-risk groups: a cost–utility analysis. Ann Intern Med 2003; 138: 176-186
9 Sikkema M, de Jonge PJ, Steyerberg EW. et al. Risk of esophageal adenocarcinoma and mortality in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010; 8: 235-244
10 Desai TK, Krishnan K, Samala N. et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut 2012; 61: 970-976
11 Yousef F, Cardwell C, Cantwell MM. et al. The incidence of esophageal cancer and high-grade dysplasia in Barrettʼs esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008; 168: 237-249
12 Thomas T, Abrams KR, De Caestecker JS. et al. Meta analysis: Cancer risk in Barrettʼs oesophagus. Aliment Pharmacol Therap 2007; 26: 1465-1477
13 Fitzgerald RC, di Pietro M, Ragunath K. et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrettʼs oesophagus. Gut 2014; 63: 7-42
14 Spechler SJ, Sharma P, Souza RF. et al. American Gastroenterological Association medical position statement on the management of Barrettʼs esophagus. Gastroenterology 2011; 140: 1084-1091
15 Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrettʼs esophagus. Am J Gastroenterol 2008; 103: 788-797
16 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrettʼs esophagus. Am J Gastroenterol 2016; 111: 30-50
17 Anaparthy R, Gaddam S, Kanakadandi V. et al. Association between length of Barrettʼs esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol 2013; 11: 1430-1436
18 Pereira AD, Chaves P. Low risk of adenocarcinoma and high-grade dysplasia in patients with non-dysplastic Barrettʼs esophagus: Results from a cohort from a country with low esophageal adenocarcinoma incidence. United European Gastroenterol J 2016; 4: 343-352
19 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Medicine 2009; 6: e1000100
20 Weston AP, Krmpotich PT, Cherian R. et al. Prospective long-term endoscopic and histological follow-up of short segment Barrett’s esophagus: comparison with traditional long segment Barrett’s esophagus. Am J Gastroenterol 1997; 92: 407-413
21 Bowers SP, Mattar SG, Smith CD. et al. Clinical and histologic follow-up after antireflux surgery for Barrettʼs esophagus. J Gastrointest Surg 2002; 6: 532-538
22 Conio M, Blanchi S, Lapertosa G. et al. Long-term endoscopic surveillance of patients with Barrett’s esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. Am J Gastroenterol 2003; 98: 1931-1939
23 Basu KK, Pick B, de Caestecker JS. Audit of a Barrett’s epithelium surveillance database. Eur J Gastroenterol Hepatol 2004; 16: 171-175
24 Vieth M, Schubert B, Lang-Schwarz K. et al. Frequency of Barrett’s neoplasia after initial negative endoscopy with biopsy: a long-term histopathological follow-up study. Endoscopy 2006; 38: 1201-1205
25 Biertho L, Dallemagne B, Dewandre JM. et al. Laparoscopic treatment of Barrett’s esophagus: long-term results. Surg Endosc 2007; 21: 11-15
26 Martinek J, Benes M, Brandtl P. et al. Low incidence of adenocarcinoma and high-grade intraepithelial neoplasia in patients with Barrett’s esophagus: a prospective cohort study. Endoscopy 2008; 40: 711-716
27 Rugge M, Zaninotto G, Parente P. et al. Barrett’s esophagus and adenocarcinoma risk: the experience of the North-Eastern Italian Registry (EBRA). Ann Surg 2012; 256: 788-794
28 Hamade N, Vennelaganti S, Parasa S. et al. Lower annual rate of progression of short-segment vs long-segment Barrett’s esophagus to esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2018;
29 Pohl H, Pech O, Arash H. et al. Length of Barrett’s oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut 2016; 65: 196-201
30 Thota PN, Vennalaganti P, Vennalaganti S. et al. Low risk of high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett’s esophagus less than 1 cm (Irregular Z-line) within 5 years of index endoscopy. Gastroenterology 2017; 152: 987-992
31 Krishnamoorthi R, Singh S, Ragunathan K. et al. Factors associated with progression of Barrett’s esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018; 16: 1046-1055
32 Schoofs N, Bisschops R, Prenen H. Progression of Barrett’s esophagus towards esophageal adenocarcinoma: an overview. Ann Gastroenterol 2017; 30: 1-6
33 Han S, Wani S. Quality indicators in Barrett's esophagus: time to change the status quo. Clin Endosc 2018; 51: 344-351