Natural history of Barrett’s esophagus over a 10-year period: a longitudinal endoscopic study in a Japanese population

Background Since Barrett’s esophagus (BE) is an established precancerous condition for esophageal adenocarcinoma, understanding the natural history of BE is crucial for effective endoscopic surveillance. We aimed to elucidate temporal changes in BE status over a 10-year period using a database derived from repeated endoscopies. Methods A total of 9,741 subjects who underwent screening esophagogastroduodenoscopy in 2014 and at least one follow-up examination by December 2025 were included. Transitions in BE status between the index and final examinations were classified as progression, regression, or no change based on differences in BE length. Logistic regression analyses were performed to investigate factors associated with BE progression. Results The median follow-up period from the index to final examination was 8.8 years. Overall, BE ≥ 1 cm or BE ≥ 2 cm was newly identified at the final examination in 4.87% and 0.82%, respectively. Progression rates toward longer BE segments remained relatively constant across age groups, ranging from the 30 s to ≥ 70 years. Multivariable regression analyses revealed significant associations between reflux esophagitis and BE progression, with higher risks observed for both Los Angeles grade A and grade B or higher esophagitis. Conclusion BE status remained stable in the majority of subjects during approximately nine years of follow-up; however, new BE ≥ 1 cm and ≥ 2 cm developed in 4.87% and 0.82% of subjects, respectively. Such progression occurred irrespective of age at baseline, providing evidence supporting flexible, adaptive surveillance strategies for BE.