Introduction There is increasing evidence that the incidence of Barrett's oesophagus (BO) is increasing and the majority of these are the short segment (SSBO) variety. At the same time the incidence of oesophageal adenocarcinoma is also on the rise. While it is generally accepted that long segment Barrett's oesophagus (LSBO) is associated with an increased risk of developing dysplasia/cancer, the risk associated with SSBO is poorly defined.
Aim To estimate the risk of developing high-grade dysplasia/cancer in patients with SSBE and LSBE undergoing surveillance endoscopy.
Methods We identified patients, from the endoscopic records of Nottingham University Hospital, with a confirmed endoscopic and histological diagnosis of BO from 2002 to 2006. Duration of follow-up was calculated from the time the first histological diagnosis of BO was made to the time of the last endoscopy. Incidence density (ID) of developing high-grade dysplasia/cancer and incidence rate ratios (IRR) were calculated in patients with SSBE and LSBE. A Poisson distribution was assumed for purposes of calculation and analysis for IRR was adjusted for age and sex. Data were analysed using Stata V.9.1.
Results 703 patients with a confirmed histological diagnosis of BO were identified from the database. 470 patients (339 male and 139 female) had LSBO and 233 patients (141 male and 92 female) had SSBO. There were 70 dysplastic lesions (54 HGD/cancer and 26 LGD) in patients with LSBO and 16 dysplastic lesions (10 HGD/cancer and six LGD) in patients with SSBO. The crude incidence density of developing HGD/cancer in patients with LSBO was 31.5/1000 pyd (person years duration) (95% CI 23.7 to 41.2) and in patients with SSBO was 15.1/1000 pyd (95% CI 7.3 to 27.8). The age and sex adjusted incidence rate ratio of developing HGD/cancer among patients with SSBO compared to LSBO was 0.99 (95% CI 0.93 to 1.06).
Conclusion The risk of developing HGD/cancer in patients with SSBO appear to be similar to those with LSBO. Surveillance guidelines and physicians need to take this into account when planning surveillance strategies for patients with SSBO.
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