Low progression risk with Barrett's esophagus less than 1 cm

Last Updated: 2016-12-29

By Will Boggs MD

NEW YORK (Reuters Health) - The risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) is very low among patients with Barrett's esophagus less than 1 cm, according to a new study.

"In a multi-center study of prospectively followed patients, none of the patients with extremely short extents of Barrett's (length <1 cm), or so-called irregular Z line, developed high-grade dysplasia or cancer during long-term follow-up," Dr. Prateek Sharma from the University of Kansas Medical Center in Kansas City told Reuters Health by email.

An estimated 5% to 20% of patients undergoing endoscopies have irregular Z line, and biopsies often show intestinal metaplasia, resulting in a diagnosis of short-segment Barrett's esophagus. When this occurs, patients are typically enrolled in surveillance programs. Whether these patients actually face an increased risk of HGD or EAC, however, is not known.

Dr. Sharma and colleagues assessed the risk of incident HGD or EAC in 167 patients with irregular Z line and compared it with that in 1,624 patients with >=1 cm of Barrett's esophagus.

During a median follow-up of 5.9 years, none of the patients with irregular Z line progressed to low-grade dysplasia (LGD) or HGD or EAC. In the group with at least 1 cm of Barrett's esophagus, 256 patients progressed to LGD, 49 to HGD, and 22 to EAC.

Moreover, during follow-up, 52.7% of patients with irregular Z line had no intestinal metaplasia, though they did at diagnosis. And none of the patients with irregular Z lines evolved into >=1 cm of Barrett's esophagus, the researchers report in Gastroenterology, online December 14.

"Do not biopsy the irregular Z line, and even if you find intestinal metaplasia, the risk of progression is not there at least for the initial 5 years," Dr. Sharma said. "If patients have intestinal metaplasia of the irregular Z line, counsel them regarding their chances of progression and that follow-up surveillance endoscopy should perhaps not be performed."

SOURCE: http://bit.ly/2hvKzQh

Gastroenterology 2016.