In October, we discussed two interesting papers about Barrett’s esophagus.
Cristal Brown presented the NEJM paper on Incidence of Adenocarcinoma among Patients with Barrett’s Esophagus (PMID 21995385). This is a large-population based study, and is demonstrates that the risk of developing esophageal adenocarcinoma in this population is lower than previously estimated. The annual risk of esophageal adenocarcinoma was 0.12%. To put this in perspective, we compared this risk to the risk of perforation associated with endoscopy. One of the drawbacks from this study is that the European population may differ somewhat from the American population. Clearly, better understanding specific risk factors that could help us to risk-stratify patients and predict esophageal adenocarcinoma will be important.
The other esophageal paper presented was a Gastroenterology paper, Risk Factors for Progression of Low-Grade Dysplasia in Patients With Barrett’s Esophagus (PMID 21723218) on progression in BE with LGD. Only 0.44% of patients with LGD progressed to EAC per year, and 1.6% of patients with LGD progressed to HGD per year. This finding calls into question the benefits of performing endoscopic ablation of BE in patients with LGD. One of the major issues highlighted by this paper is the lack of agreement between expert pathologists (inter-observer variation) about the diagnosis of LGD.
