REAL LIFE DATA FOR DYSPLASTIC BARRETT'S ESOPHAGUS MANAGEMENT AND FOLLOW-UP

Aims:

Real life data concerning the management and outcome of patients with dysplastic Barrett esophagus (BE) are scarce.

Evaluate the management and outcome of patients with dysplastic BE.

Methods:

Analyze 10 years data from a single center. All patients had dysplastic BE on ≥2 consecutive endoscopies confirmed by ≥2 dedicated pathologists.

Results:

47 out of 55 dysplastic patients fulfilled the inclusion criteria [40 LGD, 5 high grade dysplasia (HGD) and 2 with intramucosal adenocarcinoma (IMAC) at the initial diagnosis]. Age: 58.7 ± 16.2 years, 37 males, with a follow-up of 2666 patient-months (range:1 – 134, Q1 = 6, Q3 = 36). BE length > 3 cm in 15 patients. The grade of dysplasia progressed in 4 patients, all with BE > 3 cm and during the first 12 months after the initial diagnosis (2 LGD to HGD and 2 HGD to cancer). Among 31 patients with LGD without endoscopic intervention and a follow up of 1914 months, 11 regressed to non-dysplastic BE (2 – 84 months after the initial diagnosis of dysplasia) while 20 remained stable. All patients with HGD and IMAC along with 7 LGD had an endoscopic treatment (7RFA and 8 EMR followed by RFA and/or APC). Age > 55 years (p = 0.02), male gender (p = 0.066) and BE length > 3 cm (p = 0.04) favored endoscopic therapy. After treatment residual dysplasia was detected in 8/15, addressed by complementary APC sessions in 180 patient-months follow-up period while 7 remained without dysplasia for 396 patient-months. Complementary interventions for BE> 3 cm were X2.7 times more than in BE < 3 cm.

Conclusions:

1. A substantial percentage of patients with BE and LGD don't progress and may benefit from endoscopic surveillance

2. Aggravation of the dysplasia degree was detected during the first year after diagnosis

3. Age, sex and BE length influence the need for endoscopic intervention

4. The original maximal length of BE determines the need for complementary interventions.