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CC BY 4.0 · Endosc Int Open
DOI: 10.1055/a-2778-3907
Original article

Long-term outcomes of surveillance or endoscopic therapy for low-grade dysplastic Barrett’s according to a selective management algorithm

Authors

  • Tony He

    1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
    2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)

  • Mark Lai

    1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)

  • Kiran Gopinath Iyer

    1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)

  • Sara Vogrin

    3   Statistics, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)

  • John L Slavin

    4   Pathology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)

  • Edward H Tsoi 

    5   Gastroenteerology, St Vincent's Hospital (Melbourne) Limited, Fitzroy, Australia (Ringgold ID: RIN60078)
    2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)

  • Bronte Holt

    6   Center for Interventional Endoscopy, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
    2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)

  • Paul Desmond

    1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
    2   Faculty of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)

  • Andrew C F Taylor

    1   Gastroenterology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Australia (Ringgold ID: RIN60078)
    7   Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Australia (Ringgold ID: RIN85084)
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Background and study aims: Current European and American guidelines conflict in their recommendations for surveillance versus endoscopic therapy for low-grade dysplastic Barrett’s (LGD). We aimed to evaluate the performance of a selective management algorithm and provide real-world outcomes. Patients and methods: Data on 497 patients with dysplastic Barrett’s were collected prospectively between 2008 and 2022 at a Barrett’s referral unit. LGD was defined as confirmation of LGD by an expert gastrointestinal pathologist. Persistent unifocal LGD or multifocal LGD were considered high-risk features for progression and patients underwent endoscopic eradication therapy (EET). Patients with non-persistent unifocal LGD were deemed low-risk and were surveilled. Primary outcome was progression rate to high grade dysplasia or neoplasia. Results: A total of 135 patients had LGD (median [interquartile range] follow up: 4.8 years [1.0-7.1]): 22 patients met low-risk criteria and were surveilled (LR-S), eight patients met high-risk criteria and were surveilled (HR-S; patient preference n = 4, medical comorbidities n = 4), and 105 patients met high-risk criteria and underwent EET (HR-EET). Progression rates were similar between the LR-S and HR-EET cohorts (4.5% [n = 1/22] vs. 6.7% [n = 8/105]; P = 0.43). The HR-S group had a significantly higher progression rate (25% [n = 2/8]; P = 0.04). Univariable analysis showed reflux esophagitis (sub-distribution hazard ratio 3.21, 95% confidence interval 1.02-10.1, P = 0.04) was associated with progression risk in the high-risk LGD cohort only. Conclusions: This selective management algorithm for LGD is safe. Surveillance is appropriate in low-risk LGD patients. Patients with high-risk features who are surveilled and/or have reflux esophagitis may have an increased progression risk and should undergo EET with optimized acid suppression therapy.



Publication History

Received: 20 April 2025

Accepted after revision: 22 December 2025

Accepted Manuscript online:
20 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Tony He, Mark Lai, Kiran Gopinath Iyer, Sara Vogrin, John L Slavin, Edward H Tsoi, Bronte Holt, Paul Desmond, Andrew C F Taylor. Long-term outcomes of surveillance or endoscopic therapy for low-grade dysplastic Barrett’s according to a selective management algorithm. Endosc Int Open ; 0: a27783907.
DOI: 10.1055/a-2778-3907