Risk of progression in Barrett's esophagus indefinite for dysplasia: a systematic review and meta-analysis

Gastrointest Endosc. 2020 Jan;91(1):3-10.e3. doi: 10.1016/j.gie.2019.07.037. Epub 2019 Aug 14.

Abstract

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.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adenocarcinoma / epidemiology*
  • Adenocarcinoma / pathology*
  • Barrett Esophagus / epidemiology*
  • Barrett Esophagus / pathology*
  • Esophageal Neoplasms / epidemiology*
  • Esophageal Neoplasms / pathology*
  • Humans
  • Incidence
  • Risk Assessment