Background and study aims: In patients with presumed Barrett esophagus we evaluated clinical risk factors that
could predict the presence of intestinal metaplasia and dysplasia in biopsies of columnar-lined
esophagus (CLE), independently of histological results.
Patients and methods: In 908 patients with CLE of length ≥ 2 cm, data on age, sex, reflux symptoms, tobacco
and alcohol use, medication use, and upper gastrointestinal endoscopy findings were
prospectively collected. Multivariate logistic regression analysis was performed,
and a model for predicting the histological results was developed.
Results: In 127/908 patients, biopsies of CLE did not contain intestinal metaplasia. Of the
781 patients with intestinal metaplasia, 663 patients (85 %) had no dysplasia, and
118 (15 %) had low grade dysplasia (LGD). The most important predictors for the presence
of intestinal metaplasia were length of CLE, size of hiatal hernia, and male sex,
while among those with intestinal metaplasia, age and male sex were most important
for the presence of LGD. Multivariate combinations of these predictors yielded reliable
models, which were able to discriminate intestinal metaplasia well from no intestinal
metaplasia (area under receiver operating characteristic [ROC] curve 0.82), but only
reasonably discriminated LGD from no dysplasia (area under ROC 0.65).
Conclusions: A simple model based on clinical findings can be used to predict the presence of
intestinal metaplasia in biopsies from CLE. In contrast, predicting the presence of
LGD versus no dysplasia in intestinal metaplasia is more difficult. Predictions from
these models may aid decision making on whether a patient with CLE should have surveillance,
in view of the known sampling error at endoscopy and interobserver variability at
histology.
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M. Kerkhof, MD
Department of Gastroenterology and Hepatology
Erasmus MC - University Medical Center Rotterdam
PO Box 2040
3000 CA Rotterdam
The Netherlands
Fax: +31-10-4634682
Email: m.kerkhof@erasmusmc.nl
