Clinical outcomes in patients with a diagnosis of “indefinite for dysplasia” in Barrett’s esophagus: a multicenter cohort study

Preetika Sinh; Rajeswari Anaparthy; Patrick E. Young; Srinivas Gaddam; Prashanthi Thota; Gokulakrishnan Balasubramanian; Mandeep Singh; April D. Higbee; Sachin Wani; Neil Gupta; Amit Rastogi; Sharad C. Mathur; Ajay Bansal; John D. Horwhat; Brooks D. Cash; Gary W. Falk; David A. Lieberman; John J. Vargo; Richard E. Sampliner; Prateek Sharma

doi:10.1055/s-0034-1391966

Endoscopy, Table of Contents

Endoscopy 2015; 47(08): 669-674
DOI: 10.1055/s-0034-1391966

Original article

Clinical outcomes in patients with a diagnosis of “indefinite for dysplasia” in Barrett’s esophagus: a multicenter cohort study

Preetika Sinh

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Rajeswari Anaparthy

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Patrick E. Young

²Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA

,

Srinivas Gaddam

³Department of Gastroenterology, Washington University in St. Louis, St Louis, Missouri, USA

,

Prashanthi Thota

⁴Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA

,

Gokulakrishnan Balasubramanian

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Mandeep Singh

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

April D. Higbee

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Sachin Wani

⁵Division of Gastroenterology, University of Colorado, Denver, Colorado, USA

,

Neil Gupta

⁶Division of Gastroenterology, Loyola University, Maywood, Illinois, USA

,

Amit Rastogi

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Sharad C. Mathur

⁷Department of Pathology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

Ajay Bansal

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

,

John D. Horwhat

⁸Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA

,

Brooks D. Cash

²Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA

,

Gary W. Falk

⁴Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA

,

David A. Lieberman

⁹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon, USA

,

John J. Vargo

⁴Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA

,

Richard E. Sampliner

¹⁰Department of Pathology, University of Arizona Cancer Center, Tucson, Arizona, USA

,

Prateek Sharma

¹Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA

› Author Affiliations

Abstract

Background and study aim: Data are limited on the natural history of patients with Barrett’s esophagus with a diagnosis of “indefinite for dysplasia” (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy.

Patients and methods: Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett’s esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated.

Results: Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar.

Conclusions: Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.

Full Text

References

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