Postendoscopy Barrett’s Neoplasia Rates Are Low

The majority of neoplasia (high-grade dysplasia [HGD] and/or esophageal adenocarcinoma [EAC]) in patients with Barrett’s esophagus (BE) is detected at the initial endoscopy, ie, prevalent neoplasia. Some studies have reported that up to 19% of all BE neoplasia (HGD or EAC) are detected within 1 year of the initial negative endoscopy, ie, postendoscopy BE neoplasia (PEBN). In this retrospective analysis of a veteran cohort, the authors evaluated the prevalence of dysplasia and neoplasia 3 to 18 months (“missed”) after an initial diagnosis of nondysplastic BE (NDBE). 

The analysis included 402 patients with NDBE who underwent follow-up endoscopy 3 to 60 months after the initial endoscopy. Of these patients, 271 (67%; 95% males; mean age, 60.8 years) had a follow-up endoscopy 3 to 18 months later and 131 (33%; 95.4% males; mean age, 60.6 years) had follow-up endoscopy 19 to 60 months after the initial endoscopy. Among the patients who had follow-up endoscopy 3 to 18 months later, 38 (14%) progressed to indefinite dysplasia, 9 (3%) to low-grade dysplasia (LGD), 3 (1%) to HGD, and none to EAC. In the patients who had a follow-up endoscopy 19 to 60 months later, 18 (14%) progressed to indefinite dysplasia, 8 (6%) to LGD, 3 (2%) to HGD, and 1 (0.8%) to EAC. A BE length of ≥3 cm was associated with a significantly higher risk of missed dysplasia (odds ratio, 3.39; 95% confidence interval, 1.63-7.08). The authors also noted that the proportion of patients who progressed to definite dysplasia (LGD or HGD) increased significantly over time: 2.7% (3-12 months), 6.7% (13-24 months), 8.6% (25-36 months), and 12.9% (36-60 months) (P=.002).