Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Clin Gastroenterol Hepatol. 2019 Apr;17(5):869-877.e5. doi: 10.1016/j.cgh.2018.08.033. Epub 2018 Sep 11.
BACKGROUND & AIMS: The risk of esophageal adenocarcinoma (EAC) in patients with non-dysplastic Barrett's esophagus (NDBE) is low, so there is debate over the role of ongoing surveillance for patients with NDBE. It is important to identify patients at low risk for progression. We assessed cancer risk based on the subsequent number of endoscopies showing persistence of NDBE in a nationwide study in the Netherlands.
In a population-based study, patients with a first diagnosis of NDBE were selected from the Dutch nationwide registry of histopathology. We calculated incidence rates and incidence rate ratios (IRR) for high-grade dysplasia (HGD) and EAC to determine whether the number of endoscopies negative for dysplasia and the persistence of NDBE over time associate with progression to malignancy.
We identified 12,728 patients with NDBE during 2003 and 2013. HGD or EAC developed in 436 patients (3.4%) during 64,537 person-years of follow up (median, 4.9 years). The rate of progression to HGD or EAC was 0.68 (95% CI, 0.61-0.74) per 100 person-years. In patients with 2 consecutive endoscopies showing NDBE, the rate of progression to HGD or EAC decreased to 0.55 (95% CI, 0.46-0.64) per 100 person-years (IRR, 0.72; 95% CI, 0.60-0.87). Overall, the incidence of HGD or EAC decreased by 14% for each year of progression-free follow-up (IRR, 0.86; 95% CI, 0.81-0.92).
In a population-based study in the Netherlands, we found patients with stable NDBE to have a low risk of progression to HGD or EAC. These findings indicate that surveillance intervals might be lengthened or even discontinued in subgroups patients with persistent NDBE.
非异型性 Barrett 食管（NDBE）患者发生食管腺癌（EAC）的风险较低，因此对于 NDBE 患者是否需要进行持续监测存在争议。明确低风险进展的患者非常重要。我们在荷兰的一项全国性研究中，基于内镜检查中 NDBE 持续存在的后续次数来评估癌症风险。
在一项基于人群的研究中，我们从荷兰全国病理组织学登记处中选择首次诊断为 NDBE 的患者。我们计算了高级别异型增生（HGD）和 EAC 的发病率和发病率比（IRR），以确定无异型增生的内镜检查次数和随时间推移 NDBE 的持续存在与恶性进展是否相关。
我们在 2003 年至 2013 年期间共发现 12728 例 NDBE 患者。在 64537 人年的随访中（中位随访时间为 4.9 年），有 436 例（3.4%）患者发生了 HGD 或 EAC。进展为 HGD 或 EAC 的速率为 0.68（95%CI，0.61-0.74）/100 人年。在连续两次内镜检查均显示 NDBE 的患者中，进展为 HGD 或 EAC 的速率降低至 0.55（95%CI，0.46-0.64）/100 人年（IRR，0.72；95%CI，0.60-0.87）。总体而言，每 1 年无进展随访，HGD 或 EAC 的发生率降低 14%（IRR，0.86；95%CI，0.81-0.92）。
在荷兰的一项基于人群的研究中，我们发现稳定的 NDBE 患者进展为 HGD 或 EAC 的风险较低。这些发现表明，在某些亚组患者中，监测间隔时间可能会延长甚至停止。
