Digestive Diseases Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, Arizona, USA.
Gastrointest Endosc. 2020 Jan;91(1):3-10.e3. doi: 10.1016/j.gie.2019.07.037. Epub 2019 Aug 14.
Risk of progression in Barrett's esophagus (BE) with low-grade dysplasia (LGD) and high-grade dysplasia (HGD) has been established. However, the natural history of BE with indefinite dysplasia (BE-IND) remains unclear. We performed a systematic review and meta-analysis to estimate the pooled risk of progression to HGD and/or esophageal adenocarcinoma (EAC) in BE-IND.
We performed a systematic search of multiple databases to June 2018 to identify studies reporting the incidence of HGD, EAC, or HGD/EAC as an outcome in patients with BE-IND undergoing endoscopic surveillance. The pooled incidence rate of HGD and/or EAC and EAC alone was estimated.
We identified 8 studies reporting the incidence of HGD and/or EAC and 5 studies reporting the incidence of EAC in BE-IND. The pooled incidence of HGD and/or EAC (89 cases in 1441 patients over 5306.2 person-years) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0). The pooled incidence of EAC (40 cases in 1266 patients over 4520.2 person-years) was 0.6 per 100 person-years (95% CI, 0.1-1.1). Substantial heterogeneity was noted in the analyses. On subgroup analysis, the incidence of EAC was higher in studies from Europe compared with North America (0.9% vs 0.1%, P = .01). The pooled incidence of LGD was 11.4 per 100 person-years (95% CI, 0.06-0.2).
The estimated incidence of HGD and/or EAC and EAC alone in BE-IND is similar to the previously reported progression risk in BE-LGD. Based on these risk estimates, patients with BE-IND should be placed on active endoscopic surveillance.
Barrett 食管（BE）伴低级别上皮内瘤变（LGD）和高级别上皮内瘤变（HGD）的进展风险已得到证实。然而，BE 伴不确定上皮内瘤变（BE-IND）的自然史尚不清楚。我们进行了一项系统评价和荟萃分析，以估计 BE-IND 进展为 HGD 和/或食管腺癌（EAC）的风险。
我们系统地检索了多个数据库，以 2018 年 6 月为截止日期，以确定报道 BE-IND 患者接受内镜监测时 HGD、EAC 或 HGD/EAC 作为结局的发生率的研究。估计了 HGD 和/或 EAC 及 EAC 单独的总发生率。
我们确定了 8 项报道 HGD 和/或 EAC 发生率的研究和 5 项报道 BE-IND 中 EAC 发生率的研究。HGD 和/或 EAC（89 例患者，5306.2 人年共 1441 例）的总发生率为 1.5/100 人年（95%置信区间[CI]，1.0-2.0）。EAC（40 例患者，1266 例患者，4520.2 人年）的总发生率为 0.6/100 人年（95%CI，0.1-1.1）。分析中存在显著的异质性。亚组分析显示，来自欧洲的研究中 EAC 的发生率高于北美（0.9%对 0.1%，P =.01）。LGD 的总发生率为 11.4/100 人年（95%CI，0.06-0.2）。
BE-IND 中 HGD 和/或 EAC 和 EAC 单独的估计发生率与先前报道的 BE-LGD 进展风险相似。基于这些风险估计，BE-IND 患者应进行积极的内镜监测。
