Persistence of Nondysplastic Barrett's Esophagus Identifies Patients at Lower Risk for Esophageal Adenocarcinoma: Results From a Large Multicenter Cohort
Persistence of Nondysplastic Barrett's Esophagus Identifies Patients at Lower Risk for Esophageal Adenocarcinoma: Results From a Large Multicenter Cohort
复制标题
DOI：
10.1053/j.gastro.2013.05.040
复制
发表时间：
2013-09-01
期刊：
影响因子：
29.4
通讯作者：
Sharma, Prateek
中科院分区：
文献类型：
--
作者：
Gaddam, Srinivas;Singh, Mandeep;Sharma, Prateek
背景与目的：最近以人群为基础的研究表明，非发育不良Barrett‘s食道(NDBE)患者发生食管腺癌的风险较低。我们评估了持续NDBE超过多次连续监测的内窥镜检查是否可以用于Barrett‘s食道(BE)患者的风险分层。方法：我们对一大批BE患者进行了一项多中心预后研究。根据连续监测内窥镜显示NDBE的数量，我们确定了5组患者。第1组患者在第一次食道胃十二指肠镜(EGD)检查时发现NDBE。第二组的患者在他们连续的两个EGD中发现了NDBE。同样，第3、4和5组的患者在连续监测的3、4和5个EGD上发现有NDBE。建立Logistic回归模型，以确定NDBE的持久性是否独立地预防癌症的发展。结果：在总共3515名BE患者中，1401名患者符合纳入标准(93.3%的白人；87.5%的男性；中位年龄60+/-17岁)。中位随访期为5+/-3.9年(7846病人年)。第1至第5组EAC的年危险度分别为0.32%、0.27%、0.16%、0.2%和0.11%(趋势P=0.03)。在调整了年龄、性别和BE的长度后，基于多个监测内窥镜的NDBE的持久性与进展为EAC的可能性逐渐降低相关。结论：NDBE持续存在于多个内窥镜检查中，可确定发生EAC的风险较低的患者。这些发现支持延长监测间隔或停止对持续性NDBE患者的监测。
BACKGROUND & AIMS: Recent population-based studies have shown a low risk of esophageal adenocarcinoma (EAC) in patients with nondysplastic Barrett's esophagus (NDBE). We evaluated whether persistence of NDBE over multiple consecutive surveillance endoscopic examinations could be used in risk stratification of patients with Barrett's esophagus (BE). METHODS: We performed a multicenter outcomes study of a large cohort of patients with BE. Based on the number of consecutive surveillance endoscopies showing NDBE, we identified 5 groups of patients. Patients in group 1 were found to have NDBE at their first esophagogastroduodenoscopy (EGD). Patients in group 2 were found to have NDBE on their first 2 consecutive EGDs. Similarly, patients in groups 3, 4, and 5 were found to have NDBE on 3, 4, and 5 consecutive surveillance EGDs. A logistic regression model was built to determine whether persistence of NDBE independently protected against development of cancer. RESULTS: Of a total of 3515 patients with BE, 1401 patients met the inclusion criteria (93.3% white; 87.5% men; median age, 60 +/- 17 years). The median follow-up period was 5 +/- 3.9 years (7846 patient-years). The annual risk of EAC in groups 1 to 5 was 0.32%, 0.27%, 0.16%, 0.2%, and 0.11%, respectively (P for trend = .03). After adjusting for age, sex, and length of BE, persistence of NDBE, based on multiple surveillance endoscopies, was associated with a gradually lower likelihood of progression to EAC. CONCLUSIONS: Persistence of NDBE over several endoscopic examinations identifies patients who are at low risk for development of EAC. These findings support lengthening surveillance intervals or discontinuing surveillance of patients with persistent NDBE.