Abstract
Background
Barrett’s esophagus (BE) is a known complication of gastroesophageal reflux disease. In a previous study, we described a high prevalence of intestinal metaplasia (IM) in patients with an irregular Z line. However, the clinical importance of this finding is unclear.
Goals
To evaluate the long-term development of BE and relevant complications in patients diagnosed with an irregular Z line, with or without IM, on routine esophago-gastro-duodenoscopy (EGD).
Methods
In our previously described cohort, 166 out of 2000 consecutive patients were diagnosed with an incidental irregular Z line. Of those with irregular Z line, 43% had IM. In this continuation study, patients’ status was reassessed after a median follow-up of 70 months. Patients were divided into two groups: Patients with IM (IM-positive group) and without IM (IM-negative group). The incidence of long-term development of BE, dysplasia, and esophageal adenocarcinoma were compared between groups.
Results
At least one follow-up EGD was performed in 102 (61%) patients with an irregular Z line. Endoscopic evidence of BE was found in eight IM-positive patients (8/50 [16%]) and in one IM-negative patient (1/52 [1.9%]). Two (4%) IM-positive patients developed BE with low-grade dysplasia. None of the patients developed high-grade dysplasia, or esophageal adenocarcinoma.
Conclusions
Patients with irregular Z line do not develop major BE complication in more than 5 years of follow-up.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maes S, Sharma P, Bisschops R. Review: surveillance of patients with Barrett oesophagus. Best Pract Res Clin Gastroenterol. 2016;30:901–912.
Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG, clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.
di Pietro M, Chan D, Fitzgerald RC, Wang KK. Screening for Barrett’s esophagus. Gastroenterology. 2015;148:912–923.
Fitzgerald RC, di Pietro M, Ragunath K, et al. British society of gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.
Anaparthy R, Gaddam S, Kanakadandi V, et al. Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol. 2013;11:1430–1436.
Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61:970–976.
Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67:394–398.
Singh S, Manickam P, Amin AV. Incidence of esophageal adenocarcinoma in Barrett’s esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79:897–909.e4.
Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49:191–198.
Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 2011;106:1447–1455.
American Gastroenterological Association, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American gastroenterological association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091.
Pohl H, Pech O, Arash H, et al. Length of Barrett’s oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut. 2016;65:196–201.
Dickman R, Levi Z, Vilkin A, Zvidi I, Niv Y. Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line. Eur J Gastroenterol Hepatol. 2010;22:135–138.
Thota PN, Vennalaganti P, Vennelaganti S, et al. Low risk of high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett’s esophagus less than 1 cm (Irregular Z Line) within 5 years of index endoscopy. Gastroenterology. 2017;152:987–992.
Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–1536.
Pera M. Trends in incidence and prevalence of specialized intestinal metaplasia, Barrett’s esophagus, and adenocarcinoma of the gastroesophageal junction. World J Surg. 2003;27:999–1006.
Byrne JP, Bhatnagar S, Hamid B, Armstrong GR, Attwood SEA. Comparative study of intestinal metaplasia and mucin staining at the cardia and esophagogastric junction in 225 symptomatic patients presenting for diagnostic open-access gastroscopy. Am J Gastroenterol. 1999;94:98–103.
Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalovski M. Prospective evaluation of intestinal metaplasia and dysplasia within the cardia of patients with Barrett’s esophagus. Dig Dis Sci. 1997;42:597–602. https://doi.org/10.1023/A:1018811512939.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Itskoviz, D., Levi, Z., Boltin, D. et al. Risk of Neoplastic Progression Among Patients with an Irregular Z Line on Long-Term Follow-Up. Dig Dis Sci 63, 1513–1517 (2018). https://doi.org/10.1007/s10620-018-4910-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-018-4910-1