TY - JOUR
T1 - Risk of progression in Barrett's esophagus indefinite for dysplasia
T2 - a systematic review and meta-analysis
AU - Krishnamoorthi, Rajesh
AU - Mohan, Babu P.
AU - Jayaraj, Mahendran
AU - Wang, Kenneth K.
AU - Katzka, David A.
AU - Ross, Andrew
AU - Adler, Douglas G.
AU - Iyer, Prasad G.
N1 - Funding Information:
DISCLOSURE: Dr Iyer has received research funding from Exact Sciences , Medtronic , and Pentax Medical Nine Point Medical , and consulting fees from Medtronic, Pentax Medical, and Symple Surgical. Dr Wang has received funding from Abbott Diagnostics . Dr Katzka has received consulting fees from Shire and Celege. Dr Ross has received consulting fees from Boston Scientific. Dr Adler has received consulting fees from Boston Scientific. All authors disclosed no financial relationships relevant to this publication.
Publisher Copyright:
© 2020 American Society for Gastrointestinal Endoscopy
PY - 2020/1
Y1 - 2020/1
N2 - Background and Aims: Risk of progression in Barrett's esophagus (BE) with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) has been established. However, the natural history of BE with indefinite dysplasia (BE-IND) remains unclear. We performed a systematic review and meta-analysis to estimate the pooled risk of progression to HGD and/or esophageal adenocarcinoma (EAC) in BE-IND. Methods: We performed a systematic search of multiple databases to June 2018 to identify studies reporting the incidence of HGD, EAC, or HGD/EAC as an outcome in patients with BE-IND undergoing endoscopic surveillance. The pooled incidence rate of HGD and/or EAC and EAC alone was estimated. Results: We identified 8 studies reporting the incidence of HGD and/or EAC and 5 studies reporting the incidence of EAC in BE-IND. The pooled incidence of HGD and/or EAC (89 cases in 1441 patients over 5306.2 person-years) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0). The pooled incidence of EAC (40 cases in 1266 patients over 4520.2 person-years) was 0.6 per 100 person-years (95% CI, 0.1-1.1). Substantial heterogeneity was noted in the analyses. On subgroup analysis, the incidence of EAC was higher in studies from Europe compared with North America (0.9% vs 0.1%, P = .01). The pooled incidence of LGD was 11.4 per 100 person-years (95% CI, 0.06-0.2). Conclusion: The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance.
AB - Background and Aims: Risk of progression in Barrett's esophagus (BE) with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) has been established. However, the natural history of BE with indefinite dysplasia (BE-IND) remains unclear. We performed a systematic review and meta-analysis to estimate the pooled risk of progression to HGD and/or esophageal adenocarcinoma (EAC) in BE-IND. Methods: We performed a systematic search of multiple databases to June 2018 to identify studies reporting the incidence of HGD, EAC, or HGD/EAC as an outcome in patients with BE-IND undergoing endoscopic surveillance. The pooled incidence rate of HGD and/or EAC and EAC alone was estimated. Results: We identified 8 studies reporting the incidence of HGD and/or EAC and 5 studies reporting the incidence of EAC in BE-IND. The pooled incidence of HGD and/or EAC (89 cases in 1441 patients over 5306.2 person-years) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0). The pooled incidence of EAC (40 cases in 1266 patients over 4520.2 person-years) was 0.6 per 100 person-years (95% CI, 0.1-1.1). Substantial heterogeneity was noted in the analyses. On subgroup analysis, the incidence of EAC was higher in studies from Europe compared with North America (0.9% vs 0.1%, P = .01). The pooled incidence of LGD was 11.4 per 100 person-years (95% CI, 0.06-0.2). Conclusion: The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance.
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U2 - 10.1016/j.gie.2019.07.037
DO - 10.1016/j.gie.2019.07.037
M3 - Review article
C2 - 31421077
AN - SCOPUS:85072510249
VL - 91
SP - 3-10.e3
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 1
ER -