Game Changers in Gastroenterology: 2011

David A. Johnson, MD


November 23, 2011

In This Article

Risk of Malignant Progression in Barrett's Esophagus Patients: Results From a Large Population-Based Study

Bhat S, Coleman HG, Yousef F, et al.
J Natl Cancer Inst. 2011;103:1049-1057.

This was a retrospective review of a Barrett's esophagus (BE) registry of 8522 patients in Northern Ireland. Bhat and colleagues assessed rate of progression of BE to high grade dysplasia (HGD), cancers of the esophagus, or gastric cardia. The mean follow-up was 7.0 years (range, 1-22 years). Overall, HGD or cancer occurred in 0.22% of patients per year. The rate of progression to cancer did not vary between patients who had BE for 1-6 years, 6-11 years, or >11 years. Among the 46% of patients with specialized columnar metaplasia (SCM) at baseline, the risk for HGD or cancer was higher than for those without SCM at baseline (0.38% per year vs 0.07% per year).

Why Is This a Game Changer?

This is one of the largest studies to evaluate the risks for progression of BE to cancer. In contrast to the United States, European guidelines do not require biopsy evidence of SCM for the diagnosis of BE. Therefore, it would be inappropriate to apply the overall risk for progression to cancer observed in this study cohort (with and without SCM) to the US population. However, given the extremely low cancer rates in the patients without SCM, the value and cost-effectiveness of surveillance raises questions about the current "standards."


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