Outcomes of patients with Barrett's oesophagus with low-grade dysplasia undergoing endoscopic surveillance in a tertiary centre: a retrospective cohort study

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2024-09-20 DOI:10.1111/imj.16532

Luke J. Vlismas, Michael Potter, Mark R. Loewenthal, Katie Wilson, Kelleigh Allport, Donna Gillies, Dane Cook, Stephen Philcox, Steven Bollipo, Nicholas J. Talley

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引用次数: 0

Abstract

Background and Aim

Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression.

Methods

Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed.

Results

Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3–12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9–22.8; P = 0.003).

Conclusion

Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.

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在一家三级医院接受内镜监测的低度发育不良巴雷特食道患者的预后：一项回顾性队列研究。

背景和目的：巴雷特食道易患食道腺癌（OAC），随着发育不良程度（分为低度发育不良（LGD）和高度发育不良（HGD））的增加，发展为恶性肿瘤的风险也随之增加。据报道，LGD 每年发展为 OAC 的发生率从 0.02% 到 11.43% 不等。对于 LGD 患者，澳大利亚指南建议每 6 个月进行一次内镜监测。我们的目的是描述一个三级中心的监测做法，并确定监测的预测价值以及导致病情恶化的其他风险因素：方法：我们搜索了内镜和病理数据库，整理了10年来的所有巴雷特食管LGD病例。审查病历以记录患者因素、内镜和组织学细节。由于随访时间差异很大，因此采用了生存分析技术：结果：59 名患者被发现患有 LGD。13例患者（22.0%）进展为HGD或OAC（分别为10例（16.9%）和3例（5.1%））；进展为HGD/OAC和OAC的年发生率分别为5.5%和1.1%。所有发展为 OAC 的患者均未接受指导原则监测。Cox 模型发现，只有两个因素可预测病情恶化：(i) 16 例（27.1%）患者接受了符合指南的监测，其发现 HGD/OAC 病变的时间比非符合指南的监测早四倍（95% 置信区间 (CI) = 1.3-12.3；P = 0.016）。(ii) 出口内镜检查发现可见病变可独立预测病情进展（危险比 = 6.5；95% 置信区间 = 1.9-22.8；P = 0.003）：结论：伴有LGD的巴雷特食管有发展为HGD/OAC的重大风险。指南推荐的监测是有效的，但很难坚持。更有可能恶化的临床预测因素尚待确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.