World Congress at ACG2017

Simultaneous Plenary Session 4B: Esophagus / Colon

68 - Defining the Rates of Missed and Interval High-Grade Lesions in Patients With Barrett’s Esophagus: Results From a Large Multicenter Study

Wednesday, October 18
9:20 AM - 9:30 AM
Location: Valencia Ballroom D (Level 4)



Category: Esophagus       

Sravanthi Parasa, MD, MPH1, Sreekar Vennelaganti, MD2, Patrick Young, MD3, Prashanth Vennalaganti, MD4, Ajay Bansal, MD5, Srinivas Gaddam, MD6, Neil Gupta, MD7, Richard Sampliner, MD8, Gary Falk, MD9, Prashanthi N. Thota, MD10, Sharad Mathur, MD11, Brooks D. Cash, MD, FACG12, Moawad Fouad, MD3, John Vargo, MD10, Kevin Kennedy, MS2, Sophie Van Olphen, MD13, Manon Spaander, MD13, Marco Bruno, MD13, Prateek Sharma, MD2
1Case Western Reserve University School of Medicine, Cleveland, OH; 2Kansas City VA Medical Center, Kansas City, MO; 3Gastroenterology, Walter Reed National Military Center, Bethesda, MD; 4Gastroenterology, Kansas City VA Medical Center, Kansas City, MO; 5University of Kansas Medical Center, Kansas City, KS; 6Gastroenterology, Cedar Sinai Medical Center, Los Angeles, CA; 7Loyola University, Maywood, IL; 8Gastroenterology, University of Arizona, Tucson, AZ; 9Hospital of the University of Pennsylvania, Philadelphia, PA; 10Cleveland Clinic Foundation, Cleveland, OH; 11University of Kansas, Kansas City, KS; 12University of South Alabama College of Medicine, Mobile, AL; 13Erasmus Medical Centre, Rotterdam, Netherlands
Introduction: Missed and interval cancer rates at the time of index esophagogastroduodenoscopy (EGD) for patients with Barrett’s esophagus (BE) are not known. The aims of the current study were to calculate the missed dysplasia rates for low grade dysplasia (LGD), high grade dysplasia (HGD), and esophageal adenocarcinoma (EAC), and the rate of interval development of LGD/HGD/EAC among patients with BE.

Methods: Data were prospectively collected in a large, multicenter outcomes project (7 centers) involving patients with BE. BE diagnosis required the presence of columnar lined distal esophagus with intestinal metaplasia on histology. Patient demographics (age, gender, ethnicity, BMI), co-morbid conditions (diabetes, metabolic syndrome), smoking status, medication use (ASA/NSAIDs, PPI), family history of BE and cancer, and endoscopy results (BE length, presence of hiatus hernia) were recorded. Missed and Interval cases of dysplasia/EAC were ascertained using the following definitions. Missed HGD/EAC: Development of HGD/EAC within a year of initial EGD showing non-dysplastic BE (NDBE) at baseline. Interval HGD/EAC: Development of HGD/EAC between 1 and 3 years in patients with initial EGD showing NDBE at baseline Patients who did not undergo endoscopic surveillance in these time periods were excluded. Diagnosis of dysplasia/EAC was confirmed by at least 2 pathologists at the participating centers.

Results: Of 3082 patients in the database who underwent more than one EGD for BE, 2236 patients had NDBE at baseline and 552 patients underwent repeat endoscopy within 1 year and 1386 patients underwent endoscopy within 1-3 years. Missed rate of HGD/EAC was 2.9% (95% confidence interval (CI) (1.5%, 4.3%)) Missed LGD was seen in 60 patients (10.9%, 95% CI (8.3%, 13.5%). Overall, patients undergoing repeat EGD within 1 year compared to 1-3 years were more likely to be males (85.5% vs 79%, p=0.001), Caucasian (90.5% vs 85.7%, p=0.005), and had longer BE segment (3.8 +-3.5 cm vs 3.4 +- 2.9 cm, p=0.044). Of the 2236 NDBE patients, 1386 patients underwent EGD within 1-3 years. Interval HGD/EAC rate was 0.9% (95% CI) and interval LGD rate was 6.4% (95% CI).

Discussion: Using a large, multi-center database of patients with BE, we define the rates of missed and interval development of lesions in patients with non-dysplastic Barrett’s esophagus at baseline. Miss rate of HGD/EAC was 3% and miss rate for LGD was 10%, suggesting that a repeat endoscopy within 1 year of the diagnosis of BE could be beneficial.

Supported by Industry Grant: No


Missed and Interval Dysplasia/Cancer in BE patients
































Histology 

             Time to first surveillance endoscopy


 

Within 1 year (n=552)



1-3 years (n=1386)



HGD



12 [2.2% (0.9%, 3.4%  )]



9 [0.6% (0.2%, 1.1% )]


EAC

4 [0.7% (0.0%, 1.4% )]



4 [0.3% (0.0%, 0.6% )]



Combined: HGD/EAC



16 [2.9% (1.5%, 4.3%)]



13 [0.9% (0.4%, 1.4% )]


LGD

60 [10.9 %( 8.3%, 13.5%)]



89 [6.4% (5.1%, 7.7%)]



Citation: . DEFINING THE RATES OF MISSED AND INTERVAL HIGH-GRADE LESIONS IN PATIENTS WITH BARRETT’S ESOPHAGUS: RESULTS FROM A LARGE MULTICENTER STUDY. Program No. 68. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Sravanthi Parasa

Asst Professor
Case Western Reserve University School of Medicine
Cleveland, Ohio

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