ORLANDO – Barrett’s esophagus length is a readily accessible endoscopic marker for disease progression, and it could aid in risk stratification and decision making about patient management, according to a review of records at a tertiary care center.
Of 301 patients who were diagnosed with Barrett’s esophagus and who underwent radiofrequency ablation (RFA) between March 2006 and 2016, 106 met a standardized definition of Barrett’s esophagus and were included in the study on the basis of the remaining criteria, including having nondysplastic Barrett’s esophagus and at least 1 year of follow-up from the time of initial diagnosis.
Of those 106 patients, 53 progressed to high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC). The overall annual risk of EAC and combined HGD/EAC for the entire cohort was 1.23%/year and 5.94%/year, respectively. Those who progressed had significantly longer Barrett’s esophagus length, compared with 53 nonprogressors (6.37 cm vs. 4.3 cm).
Sharon Worcester/Frontline Medical News
Dr. Joseph Spataro and Dr. Christina Tofani
After adjustment for sex and number of RFA treatments, length of Barrett’s esophagus segment was found to be a significant independent predictor of progression to adenocarcinoma (odds ratio, 1.16), Joseph Spataro, MD, and his colleagues at Thomas Jefferson University Hospital, Philadelphia, reported in a poster at the World Congress of Gastroenterology at ACG 2017.
In fact, of all characteristics assessed, including Barrett’s esophagus length, age, sex, race, mean body mass index, family history of esophageal cancer, proton pump inhibitor use, and total duration of follow-up, only the first was a significant predictor of progression.
“For every 1-cm increase in length of BE [Barrett’s esophagus], the risk of progression to EAC increases by 16%,” Dr. Spataro said.
Although this work, which was awarded a “Presidential Poster” ribbon, is limited by the retrospective design, lack of standardization of surveillance intervals and biopsy protocols, and by the possibility of elevated progression rates due to the nature of the center (a referral center with ablative therapy options), the study included a “decent sample and follow-up,” and has important implications for patient care, he noted, explaining that the incidence of EAC has increased faster than any other malignancy in the Western world.
Despite therapeutic advances, the prognosis for patients with EAC remains poor; the annual risk of progression from Barrett’s esophagus to HGD is 0.38%, he added.
Currently, the most commonly used risk-stratification tool for determining surveillance intervals and management of patients with Barrett’s esophagus is the degree of dysplasia. Prior studies have evaluated Barrett’s esophagus length as a predictor of progression to HGD/EAC, but findings have been conflicting, he said.
The current findings suggest that until molecular biomarkers are identified and validated as adjunctive tools for risk stratification, Barrett’s esophagus length could be used to identify patients with nondysplastic Barrett’s esophagus at risk for disease progression.
This could facilitate more rational tailoring of endoscopic surveillance, explained lead author Christina Tofani, MD.
Currently, Barrett’s esophagus patients at the center who have dysplasia generally undergo ablation, while those without dysplasia generally undergo surveillance. Barrett’s esophagus length could be used to adjust surveillance intervals, or to lower the bar for ablation in some cases, she said.