Endoscopy 2007; 39(7): 581-587
DOI: 10.1055/s-2007-966592
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Low-grade dysplasia in Barrett's esophagus has a high risk of progression

C.  H.  Lim1 , D.  Treanor2 , M.  F.  Dixon2 , A.  T.  R.  Axon3
  • 1Department of Gastroenterology, Good Hope Hospital, Sutton Coldfield, United Kingdom
  • 2Department of Histopathology, Leeds General Infirmary, Leeds, United Kingdom
  • 3Centre for Digestive Diseases, Leeds General Infirmary, Leeds, United Kingdom
Further Information

Publication History

submitted 4 January 2007

accepted after revision 30 April 2007

Publication Date:
05 July 2007 (online)

Background and study aims: Surveillance in Barrett's esophagus relies on the detection of dysplasia by histopathology. However, the natural history of this condition, particularly that of low-grade dysplasia (LGD) is poorly understood. This paper describes our experience of LGD over a period of 21 years.

Patients and methods: Between 1984 and January 1995, 357 patients with Barrett's esophagus without dysplasia were recruited for annual surveillance: 34 of these patients developed LGD during this period. This was a retrospective cohort study of this group in terms of survival and cancer outcomes ≥ 8 years after the original diagnosis of LGD, comparing them with the patients who did not develop LGD over the same period, with a histopathological review of the original diagnoses of LGD. The outcomes of 356/357 (99.7 %) of the patients were established in December 2004.

Results: After 8 years, high-grade dysplasia (HGD) or cancer had developed in 9/34 patients with LGD (27 %) and in 16/322 controls (5 %). Cox’s proportional hazards model revealed that the time from the first diagnosis of Barrett's esophagus to the first “event” of either HGD, esophageal cancer, or death did not show a statistically significant difference between the two groups. A further analysis treating death as “loss to follow-up” showed a significantly increased risk for the LGD group to progress to HGD or cancer (hazard ratio 5.9 [95 % confidence interval 2.6 - 13.4], P< 0.001). The histopathology review demonstrated a fair level of agreement between pathologists, with a kappa value of 0.48.

Conclusions: Patients diagnosed with LGD during surveillance of Barrett's esophagus are at a considerably increased risk of progressing to develop esophageal cancer over an 8-year period but most deaths are not cancer-related.

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C. H. Lim, MD

Department of Gastroenterology

Good Hope Hospital

Rectory Road

Sutton Coldfield

West Midlands B75 7RR

United Kingdom

Fax: +44-121-3786095

Email: Chee.Lim@heartofengland.nhs.uk

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