Annals of Surgery

Skip Navigation LinksHome > November 2012 - Volume 256 - Issue 5 > Barrett's Esophagus and Adenocarcinoma Risk: The Experience...
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‡‡‡

Collapse Box


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.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.