Barrett’s esophagus with low-grade dysplasia: high rate of upstaging at Barrett’s esophagus referral units suggests progression rates may be overestimated.

The reported progression rate from low-grade dysplasia (LGD) in Barrett’s esophagus (BE) to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) ranges from 0.4% to 13.4% per year. We hypothesize that some of the reported progression rates may be overestimated due to prevalent HGD or EAC, which was not identified during endoscopic assessments performed in the community. The aim is to determine the proportion of prevalent HGD or EAC detected by Barrett’s esophagus referral units (BERU) in patients referred from the community with a recent diagnosis of LGD.
All patients referred from the community to 6 BERU with a diagnosis of BE with LGD were identified. Patients with an assessment endoscopy performed at BERU more than 6 months from their referral endoscopy in the community were excluded. Visible lesions and histology outcomes were compared between the community referral endoscopy and the assessment endoscopy performed at BERU.
The median time between BERU assessment and the referral endoscopy was 79 days (IQR 54-114). Of the 75 patients referred from the community with LGD, BERU assessment identified HGD or EAC in 20 (27%) patients. BERU assessment identified more visible lesions than referral endoscopy performed in the community 39 (52%) versus 9 (12%), respectively, p=0.029.
BERU assessment endoscopy identified more visible lesions than community referral endoscopy and identified HGD or EAC in 27% of patients referred from the community with a recent diagnosis of LGD. Reported progression rates from LGD to HGD or EAC may be overestimated.

Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.