Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
Endoscopy. 2019 Jul;51(7):665-672. doi: 10.1055/a-0869-7960. Epub 2019 Apr 2.
Although shorter lengths of Barrett's esophagus (BE) have been associated with a lower risk of neoplastic progression, precise estimates have varied, especially for non-dysplastic BE (NDBE) only. Therefore, current US guidelines do not provide specific recommendations on surveillance intervals based on BE length. We performed a systematic review and meta-analysis of the published literature to examine neoplastic progression rates of NDBE based on BE length.
PubMed, Cochrane, Google Scholar, and Embase were comprehensively searched. Studies reporting progression rates in patients with NDBE and > 1 year of follow-up were included. The number of patients progressing to esophageal adenocarcinoma (EAC) and high grade dysplasia (HGD)/EAC in individual studies and the mean follow-up were recorded to derive person-years of follow-up. Pooled rates of progression to EAC and HGD/EAC based on BE length (< 3 cm vs. ≥ 3 cm) were calculated.
Of the 486 initial studies identified, 10 met the inclusion/exclusion criteria. These included a total of 4097 NDBE patients; 1979 with short-segment BE (SSBE; 10 773 person-years of follow-up) and 2118 with long-segment BE (LSBE; 12 868 person-years). The annual rates of progression to EAC were significantly lower for SSBE compared with LSBE: 0.06 % (95 % confidence interval 0.01 % - 0.10 %) vs. 0.31 % (0.21 % - 0.40 %), respectively; odds ratio (OR) 0.25 (0.11 - 0.56); < 0.001, as were the rates for the combined endpoint (HGD/EAC): 0.24 % (0.09 % - 0.32 %) vs. 0.76 % (0.43 % - 0.89 %), respectively; OR 0.35 (0.21 - 0.58); < 0.001. There was no significant heterogeneity among studies.
The results demonstrate significantly lower rates of neoplastic progression in NDBE patients with SSBE compared with LSBE. BE length can easily be used for risk stratification purposes for NDBE patients undergoing surveillance endoscopy and consideration should be given to tailoring surveillance intervals based on BE length in future US guidelines.
尽管较短的 Barrett 食管（BE）长度与较低的肿瘤进展风险相关，但精确的估计值存在差异，尤其是对于非异型增生性 BE（NDBE）。因此，目前的美国指南并未根据 BE 长度提供关于监测间隔的具体建议。我们进行了系统的文献综述和荟萃分析，以检查基于 BE 长度的 NDBE 肿瘤进展率。
全面检索了 PubMed、Cochrane、Google Scholar 和 Embase。纳入了报告 NDBE 患者和> 1 年随访的进展率的研究。记录个别研究中进展为食管腺癌（EAC）和高级别异型增生（HGD）/EAC 的患者数量以及平均随访时间，以得出随访人年数。根据 BE 长度（< 3cm 与≥3cm）计算进展为 EAC 和 HGD/EAC 的汇总率。
在最初的 486 项研究中，有 10 项符合纳入/排除标准。这些研究共纳入了 4097 例 NDBE 患者，其中 1979 例为短节段 BE（SSBE；10773 人年随访），2118 例为长节段 BE（LSBE；12868 人年随访）。与 LSBE 相比，SSBE 的 EAC 进展年发生率明显较低：分别为 0.06%（95%置信区间 0.01%-0.10%）和 0.31%（0.21%-0.40%）；比值比（OR）为 0.25（0.11-0.56）； ＜0.001，联合终点（HGD/EAC）的发生率也较低：分别为 0.24%（0.09%-0.32%）和 0.76%（0.43%-0.89%）；OR 为 0.35（0.21-0.58）； ＜0.001。研究之间无显著异质性。
结果表明，与 LSBE 相比，SSBE 的 NDBE 患者肿瘤进展率明显较低。BE 长度可用于接受监测内镜检查的 NDBE 患者的风险分层目的，在未来的美国指南中，应考虑根据 BE 长度调整监测间隔。
