The natural history of low-grade dysplasia in Barrett's esophagus and risk factors for progression

Mohamed Hussein; Vinay Sehgal; Sarmed Sami; Paul Bassett; Rami Sweis; David Graham; Andrea Telese; Danielle Morris; Manuel Rodriguez-Justo; Marnix Jansen; Marco Novelli; Matthew Banks; Laurence B Lovat; Rehan Haidry

doi:10.1002/jgh3.12625

The natural history of low-grade dysplasia in Barrett's esophagus and risk factors for progression

JGH Open. 2021 Aug 6;5(9):1019-1025. doi: 10.1002/jgh3.12625. eCollection 2021 Sep.

Authors

Mohamed Hussein^{1

2

3}, Vinay Sehgal², Sarmed Sami², Paul Bassett⁴, Rami Sweis², David Graham², Andrea Telese², Danielle Morris², Manuel Rodriguez-Justo⁵, Marnix Jansen⁵, Marco Novelli⁵, Matthew Banks², Laurence B Lovat^{1

2

3}, Rehan Haidry^{1

2

3}

Affiliations

¹ Division of surgery and interventional science University College London (UCL) London UK.
² Department of Gastroenterology University College London Hospital London UK.
³ Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) University College London London UK.
⁴ Statsconsultancy Ltd Amersham UK.
⁵ Department of Histopathology UCL London UK.

Abstract

Background and aim: Barrett's esophagus is associated with increased risk of esophageal adenocarcinoma. The optimal management of low-grade dysplasia arising in Barrett's esophagus remains controversial. We performed a retrospective study from a tertiary referral center for Barrett's esophagus neoplasia, to estimate time to progression to high-grade dysplasia/esophageal adenocarcinoma in patients with confirmed low-grade dysplasia compared with those with downstaged low-grade dysplasia from index presentation and referral. We analyzed risk factors for progression.

Methods: We analyzed consecutive patients with low-grade dysplasia in Barrett's esophagus referred to a single tertiary center (July 2006-October 2018). Biopsies were reviewed by at least two expert pathologists.

Results: One hundred and forty-seven patients referred with suspected low-grade dysplasia were included. Forty-two of 133 (32%) of all external referrals had confirmed low-grade dysplasia after expert histopathology review. Multivariable analysis showed nodularity at index endoscopy (P < 0.05), location of dysplasia (P = 0.05), and endoscopic therapy after referral (P = 0.09) were associated with progression risk. At 5 years, 59% of patients with confirmed low-grade dysplasia had not progressed versus 74% of patients in the cohort downstaged to non-dysplastic Barrett's esophagus.

Conclusion: Our data show variability in the diagnosis of low-grade dysplasia. The cumulative incidence of progression and time to progression varied across subgroups. Confirmed low-grade dysplasia had a shorter progression time compared with the downstaged group. Nodularity at index endoscopy and multifocal low-grade dysplasia were significant risk factors for progression. It is important to differentiate these high-risk subgroups so that decisions on surveillance/endotherapy can be personalized.

Keywords: Barrett's esophagus; endoscopy; gastroenterology.