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Prevalence of esophageal neoplasia in short-segment versus long-segment Barrett’s esophagus

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Abstract

Background

With heightened awareness of the increasing rate of esophageal adenocarcinoma and success of endotherapy for Barrett’s neoplasia, our Barrett’s center has seen a rise in referrals for evaluation and management of Barrett’s esophagus. We sought to compare the prevalence of neoplasia in patients with short- (<3 cm) versus long-segment Barrett’s esophagus (≥3 cm) referred to our Barrett’s center.

Methods

We performed a retrospective analysis of endoscopic procedures and pathology reports in adult patients (age >18) referred to our Barrett’s center over a 6-year period. Neoplasia was defined as low-grade dysplasia, high-grade dysplasia and superficial esophageal adenocarcinoma. Outcome measures included the prevalence of neoplasia in short- vs long-segment Barrett’s esophagus.

Results

Four-hundred and eighty-five patients (74 % male) were identified; 51 % had short-segment and 49 % had long-segment Barrett’s esophagus. The prevalence of neoplasia in short- vs long-segment Barrett’s esophagus was 33.6 vs 59.1 % (low-grade dysplasia 8.0 vs 14.5 %, high-grade dysplasia 12.8 vs 24.7 %, esophageal adenocarcinoma 12.8 vs 20.0 %). Long-segment Barrett’s esophagus was associated with 2.55-fold increase in odds of neoplasia relative to the short-segment group (OR 2.55, p < 0.001, CI 1.73–3.76).

Conclusion

Neoplasia was more prevalent in patients with long-segment Barrett’s. Surprisingly, 23.4 % of patients with an “irregular Z line” harbored advanced neoplasia (high grade dysplasia or esophageal adenocarcinoma) in our biased referral population. This suggests that patients with an “irregular Z line” should be biopsied and, if intestinal metaplasia is detected, surveyed per established Barrett’s esophagus guidelines.

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Authors and Affiliations

  1. Department of Medicine, UPMC Presbyterian, M2, C Wing, 200 Lothrop St, Pittsburgh, PA, 15213, USA

    Joy Chang, Kenneth Fasanella, Jennifer Chennat & Kevin McGrath

  2. Department of Pathology, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA, 15213, USA

    Jon Davison

Authors
  1. Joy Chang
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  2. Kenneth Fasanella
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  3. Jennifer Chennat
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  4. Jon Davison
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  5. Kevin McGrath
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Correspondence to Kevin McGrath.

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This article does not contain any studies with human or animal subjects performed by any authors.

Conflict of interest

Drs. Chang, Fasanella, Chennat and Davison declare that they have no conflict of interest. Dr. McGrath serves as a consultant to Boston Scientific Corp.

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Chang, J., Fasanella, K., Chennat, J. et al. Prevalence of esophageal neoplasia in short-segment versus long-segment Barrett’s esophagus. Esophagus 13, 151–155 (2016). https://doi.org/10.1007/s10388-015-0507-3

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  • DOI: https://doi.org/10.1007/s10388-015-0507-3

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