THE NATURAL COURSE OF UNTREATED NEOPLASIA IN BARRETT’S ESOPHAGUS – A CASE-SERIES

Aims Endoscopic therapy(ET) is initiated for Barrett’s Esophagus with HGD to prevent non-curable esophageal adenocarcinoma (EAC). Risk estimates for progression to clinically evident EAC are crucial for rational use of ET. We aimed to evaluate time between HGD-diagnosis in BE and development of clinically evident EAC.

Methods From the nationwide Dutch Barrett Expert Center registry cases with untreated HGD and follow-up>12 months were selected. Data was retrospectively collected. Endoscopic follow-up: time between HGD-detection (baseline) and last endoscopy. Vital follow-up: time between baseline and symptomatic EAC, death, or last data collection. Primary outcome: time of progression to clinically evident EAC(=symptomatic EAC (dysphagia) or EAC-related death).

Results Eleven cases met inclusion criteria (n=11/2091; mean age 78) with HGD-diagnosis from abnormalities (9/11 pts; 82%) or in random biopsies from flat BE (2/11 pts; 18%). Median endoscopic follow-up was 21 months(IQR2-32) and median vital follow-up 27 months(IQR21-45). Overall, 4/11 patients (36%) progressed to clinically evident symptomatic EAC after median 52 months (range 17-78) and eventually died from EAC. Endoscopic follow-up was terminated median 30 months(IQR16-44) prior to progression. Three patients (3/11) had endoscopic suspicion of progression and underwent endoscopic resection for HGD (n=1) or T1-EAC (n=2) after 19-21-26 months. The remaining patients had median 26 months vital follow-up (IQR16-41) without progression and unrelated death (n=3), or were alive (n=1).

Conclusions Even though HGD and early EAC are logical targets for ET, the actual progression to symptomatic disease had a significant duration and this delay may be relevant to consider in patients with a limited life expectancy.

Publication History

Article published online:
14 April 2022