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Annals of Surgery:
doi: 10.1097/SLA.0b013e3182737a7e
Original Articles From the ESA Proceedings

Barrett's Esophagus and Adenocarcinoma Risk: The Experience of the North-Eastern Italian Registry (EBRA)

Rugge, Massimo MD*; Zaninotto, Giovanni MD; Parente, Paola MD; Zanatta, Lisa MD; Cavallin, Francesco MS§; Germanà, Bastianello MD; Macrì, Ettore MD; Galliani, Ermenegildo MD; Iuzzolino, Paolo MD; Ferrara, Francesco MD; Marin, Renato MD; Nisi, Emiliano MD; Iaderosa, Gaetano MD; DeBoni, Michele MD#; Bellumat, Angelo MD#; Valiante, Flavio MD#; Florea, Georgeta MD#; Della Libera, Duilio MD#; Benini, Marco MD**; Bortesi, Laura MD**; Meggio, Alberto MD††; Zorzi, Maria G. MD††; Depretis, Giovanni MD‡‡; Miori, Gianni MD‡‡; Morelli, Luca MD‡‡; Cataudella, Giovanni MD§§; D'Amore, Emanuele MD§§; Franceschetti, Ilaria MD§§; Bozzola, Loredana MD§§; Paternello, Elisabetta MD‖‖; Antonini, Cristina MD‖‖; Di Mario, Francesco MD¶¶; Dal Bò, Nadia MD¶¶; Furlanetto, Alberto MD¶¶; Norberto, Lorenzo MD##; Polese, Lino MD##; Iommarini, Silvia MD##; Farinati, Fabio MD##; Battaglia, Giorgio MD§; Diamantis, Giorgio MD§; Realdon, Stefano MD§; Guido, Ennio MD***; Mastropaolo, Gaetano MD†††; Canova, Daniele MD†††; Guerini, Antonello MD†††; Franceschi, Marilisa MD‡‡‡; Zirillo, Maurizio MD‡‡‡

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Abstract

Objective: To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)].

Background: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer.

Methods: In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression.

Results: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2–4); median follow-up = 44.6 [IQR: 24.7–60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51–68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9–50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63–21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22–11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03–1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN.

Conclusions: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

© 2012 Lippincott Williams & Wilkins, Inc.

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