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:
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A substantial percentage of patients with BE and LGD don't progress and may benefit from endoscopic surveillance
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Aggravation of the dysplasia degree was detected during the first year after diagnosis
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Age, sex and BE length influence the need for endoscopic intervention
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The original maximal length of BE determines the need for complementary interventions.
