Abstract
Introduction The cancer risk in patients with minimal Barrett’s oesophagus (BO) disease is thought to be low, but there remains uncertainty about the requirement of follow up in patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) and BO without IM. The aim of this study is to investigate the neoplastic progression rate in patients with minimal Barrett’s disease.
Methods In this single-centre prospective longitudinal cohort study, we included patients with BO maximum 2cm in length and gastric metaplasia only (BO-GM) and patients with IM within an irregular z-line (GOJ-IM). Patients with BO-GM at index endoscopy, who were reclassified at later timepoints to irregular z-line only, were included in a separate category (GOJ-GM). Patient received a minimum of 2 endoscopies with oesophageal and GOJ biopsies at least 12 months apart. Patients with high grade dysplasia (HGD) or oesophageal adenocarcinoma (OAC) at index endoscopy or within 12 months after index endoscopy were excluded. Primary outcome was diagnosis of BO-related dysplasia or OAC. One-way ANOVA testing and Bonferroni correction was performed to analyse difference among groups.
Results A total of 212 patients were included (BO-GM n=112; GOJ-IM n=69; GOJ-GM n=32). The total number of patient-years follow-up was 1955. The majority of patients (97%) was on proton pump inhibitors. Two patients were diagnosed with 2 patients were diagnosed with transient LGD and both belong in Group 2. The overall yearly incidence to any grade of neoplasia was 0.15% / year with no significant difference among the groups. One patient developed OAC, after 13 years of index endoscopy. This is a male patient who was lansoprazole 15mg BD. He was discharged due to lack of visible Barrett’s oesophagus and focal IM only at the GOJ. He presented symptomatically 7 years after discharge with Stage IV OAC. The overall cancer progression rate was 0.05% year.
Methods In this single-centre prospective longitudinal cohort study, we included patients with BO maximum 2cm in length and gastric metaplasia only (BO-GM) and patients with IM within an irregular z-line (GOJ-IM). Patients with BO-GM at index endoscopy, who were reclassified at later timepoints to irregular z-line only, were included in a separate category (GOJ-GM). Patient received a minimum of 2 endoscopies with oesophageal and GOJ biopsies at least 12 months apart. Patients with high grade dysplasia (HGD) or oesophageal adenocarcinoma (OAC) at index endoscopy or within 12 months after index endoscopy were excluded. Primary outcome was diagnosis of BO-related dysplasia or OAC. One-way ANOVA testing and Bonferroni correction was performed to analyse difference among groups.
Results A total of 212 patients were included (BO-GM n=112; GOJ-IM n=69; GOJ-GM n=32). The total number of patient-years follow-up was 1955. The majority of patients (97%) was on proton pump inhibitors. Two patients were diagnosed with 2 patients were diagnosed with transient LGD and both belong in Group 2. The overall yearly incidence to any grade of neoplasia was 0.15% / year with no significant difference among the groups. One patient developed OAC, after 13 years of index endoscopy. This is a male patient who was lansoprazole 15mg BD. He was discharged due to lack of visible Barrett’s oesophagus and focal IM only at the GOJ. He presented symptomatically 7 years after discharge with Stage IV OAC. The overall cancer progression rate was 0.05% year.
| Original language | Undefined |
|---|---|
| Journal | Gut |
| DOIs | |
| Publication status | Published - Jun 2023 |