St James's Hospital, Dublin, Ireland.
Mercy University Hospital Cork, Cork, Ireland.
Dis Esophagus. 2020 Oct 12;33(10). doi: 10.1093/dote/doaa009.
Barrett's esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett's epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19-4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context.
巴雷特食管（BE）是食管腺癌（EAC）的主要病理前体。从非异型增生性 BE（NDBE）、低级别异型增生（LGD）和不确定异型增生（IND）进展为高级别异型增生（HGD）或 EAC，在基于人群的研究和专门的中心之间因多种原因而有很大差异，主要原因是活检方案的严格程度和病理定义的准确性。在爱尔兰共和国，2011 年建立了一个多中心前瞻性注册和生物资源（RIBBON），涉及六个学术医疗中心，本文代表了该网络的第一份报告。一个详细的临床、内镜和病理数据库登记了 3557 名患者。BE 通过 Barrett 上皮的内镜证据和特殊的肠上皮化生（SIM）的存在严格定义。一个前瞻性的基于网络的数据库用于收集信息，每个站点的数据管理员提取初始和随访数据。共有 2244 名患者，1925 名无异型增生，随访完整。诊断时的中位年龄为 60.5 岁，男女比例为 2.1:1，中位随访时间为 2.7 年（IQR 1.19-4.04），随访 6609.25 人年。在此期间，125 名（5.57%）进展为 HGD/EAC，其中 74 名（3.3%）在随访 1 年后，38 名（1.69%）进展为 EAC，其中 20 名（0.89%）在 1 年后。HGD/EAC 的总体发生率为每年 1.89%；排除第一年则为每年 1.16%。总体上，EAC 的进展风险为每年 0.57%，排除第一年则为每年 0.31%，在诊断时仅存在 SIM 的 1925 名患者中为每年 0.21%。低级别异型增生（LGD）在 31%的患者中进展为 HGD/EAC，每年进展率为 12.96%，排除第一年则为每年 6.71%。在爱尔兰学术中心的国家合作中，NDBE 的进展率与最近的人群研究相似。几乎有一半的进展发生在 1 年内。至关重要的是，由专业胃肠病理学家诊断和确认的 LGD 代表真正的高风险疾病，这突出了在这方面诊断和管理专业知识的重要性，并为消融治疗提供了间接支持。
