Abstract Background Barrett’s esophagus (BE) is a risk factor for esophageal adenocarcinoma (EAC) and encompasses a spectrum of cancer risk from non-dysplastic BE(NDBE) to indefinite for dysplasia(IND), low grade dysplasia (LGD) and high grade dysplasia (HGD). The risk of progression to HGD/EAC however remains uncertain, and varies widely according to definitions, diagnostic protocols and pathologic expertise. With the overall goal of reducing mortality from EAC by targeting early diagnosis, a National Registry of BE was established in Ireland in 2011 across endoscopic centres. This prospective registry study provides an analysis of progression rates in a real-world, prospective, multicenter setting. Methods A prospective, longitudinal cohort study of the BE Registry was performed up to October 2024. BE was defined by specialised intestinal metaplasia (SIM). Data were collected using a web-based system by dedicated data managers at each site. Person years were calculated as time to progression or last follow-up. Progression rates with 95% confidence intervals (CI) were calculated. Kaplan–Meier curves were constructed for the time to progression according to category at index biopsy. Results A total of 9436 patients were included. Of these, 5331 patients with NDBE, ID, or LGD were analysed for progression risk. The 5-year cumulative risk for progression to HGD/EAC was 2.7% for NDBE, 12.2% for ID and 34.7% for LGD (P 0.0001) (Fig. 1). Excluding the first year of follow-up, the 5-year cumulative risk for progression to HGD/EAC was 5.6% for NDBE, 22.7% for ID and 39.6% for LGD (P = 0.0001). Risk factors for progression identified on multivariable analysis include male gender (P 0.004), age at diagnosis (P 0.001) and length of Barrett’s segment (P 0.001). Conclusion Progression from NDBE was higher than reported population studies, most strikingly however one fifth of those with IND and ~ 35% with LGD advanced to HGD or EAC at 5- years, underscoring the importance of expert dysplasia grading. Risk factors for progression included male gender, age at diagnosis and BE segment length. This National Registry provides a comprehensive database that facilitates better understanding of patient outcomes through guideline based surveillance underpinned by expert pathology and endoscopy, and prospective data management. Such initiatives will improve knowledge of Barrett’s carcinogenesis and inform future clinical guidelines.
Raftery et al. (Fri,) studied this question.