Department of Gastroenterology, Gosford Hospital, Gosford, New South Wales, Australia.
Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia.
Intern Med J. 2024 Nov;54(11):1867-1875. doi: 10.1111/imj.16532. Epub 2024 Sep 20.
Barrett's oesophagus predisposes individuals to oesophageal adenocarcinoma (OAC), with the risk of progression to malignancy increasing with the degree of dysplasia, categorized as either low-grade dysplasia (LGD) or high-grade dysplasia (HGD). The reported incidence of progression to OAC in LGD ranges from 0.02% to 11.43% per annum. In patients with LGD, Australian guidelines recommend 6-monthly endoscopic surveillance. We aimed to describe the surveillance practices within a tertiary centre, and to determine the predictive value of surveillance as well as other risk factors for progression.
Endoscopy and pathology databases were searched over a 10-year period to collate all cases of Barrett's oesophagus with LGD. Medical records were reviewed to document patient factors and endoscopic and histologic details. Because follow-up times varied greatly, survival analysis techniques were employed.
Fifty-nine patients were found to have LGD. Thirteen patients (22.0%) progressed to either HGD or OAC (10 (16.9%) and three (5.1%) respectively); the annual incidence rates of progression to HGD/OAC and OAC were 5.5% and 1.1% respectively. All patients who developed OAC had non-guideline-adherent surveillance. A Cox model found only two predictors of progression: (i) guideline-adherent surveillance, performed in 16 (27.1%), detected progression to HGD/OAC four times earlier than non-guideline-adherent surveillance (95% confidence interval (CI) = 1.3-12.3; P = 0.016). (ii) The detection of visible lesions at exit endoscopy independently predicted progression (hazard ratio = 6.5; 95% CI = 1.9-22.8; P = 0.003).
Barrett's oesophagus with LGD poses a significant risk of progression to HGD/OAC. Guideline-recommended surveillance is effective, but is difficult to adhere to. Clinical predictors for those who are more likely to progress are yet to be defined.
巴雷特食管使个体易患食管腺癌（OAC），其恶性转化的风险随着异型增生的程度而增加，异型增生分为低级别异型增生（LGD）或高级别异型增生（HGD）。LGD 进展为 OAC 的报告发病率为每年 0.02%至 11.43%。在 LGD 患者中，澳大利亚指南建议每 6 个月进行内镜监测。我们旨在描述三级中心的监测实践，并确定监测的预测价值以及其他进展的危险因素。
在 10 年期间，通过搜索内镜和病理数据库来收集所有患有 LGD 的 Barrett 食管病例。审查病历以记录患者因素以及内镜和组织学细节。由于随访时间差异很大，因此使用生存分析技术。
发现 59 例患者患有 LGD。13 例（22.0%）进展为 HGD 或 OAC（分别为 10 例[16.9%]和 3 例[5.1%]）；进展为 HGD/OAC 和 OAC 的年发生率分别为 5.5%和 1.1%。所有发生 OAC 的患者均未进行符合指南的监测。Cox 模型仅发现两个进展的预测因素：（i）16 例（27.1%）进行了符合指南的监测，比不符合指南的监测早发现 HGD/OAC 进展了 4 倍（95%置信区间（CI）= 1.3-12.3；P=0.016）。（ii）在出口内镜下检测到可见病变独立预测进展（危险比=6.5；95%CI=1.9-22.8；P=0.003）。
LGD 巴雷特食管有进展为 HGD/OAC 的显著风险。推荐的监测符合指南，但难以遵守。尚未确定哪些患者更有可能进展的临床预测因素。
