Audit of a Barrett's epithelium surveillance database

Eur J Gastroenterol Hepatol. 2004 Feb;16(2):171-5. doi: 10.1097/00042737-200402000-00008.


Background: Barrett's epithelium is a premalignant condition in which endoscopic surveillance is recommended but remains contentious.

Aim: To audit our Barrett's epithelium surveillance database and to calculate the incidence and natural history of dysplasia and cancer in this cohort.

Methods: A retrospective analysis of a computerised database of patients with columnar lined oesophagus containing specialised intestinal metaplasia was undertaken over a 5-year period. The surveillance protocol was annual endoscopy with 2-cm interval quadrantic biopsies with patients on continuous acid-suppression therapy.

Results: A total of 138 (102 men) patients underwent active surveillance. The mean age was 62.1 years and the mean Barrett's epithelium length was 5.9 cm. Ten patients had low-grade dysplasia, with a mean age of 73.5 years, a mean Barrett's epithelium length of 7.8 cm, a prevalence of 7.2% over 5 years and an incidence of 1.4% per annum. Low-grade dysplasia regressed in five patients, persisted in four patients, and was associated with a concurrent squamous carcinoma in one patient. Three patients had high-grade dysplasia at index endoscopy, with no incident cases. One progressed to adenocarcinoma after 2 years. A cancer incidence of one per 202 patient-years of surveillance was found, equivalent to 0.5% per year.

Conclusion: Short-interval (1-year) endoscopic surveillance of Barrett's epithelium offers little reward. Low-grade dysplasia is uncommon, and no progression to adenocarcinoma was seen in this cohort. No incident high-grade dysplasia was observed. Prospective evaluation of a longer endoscopic surveillance interval in controlled clinical studies is warranted.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / complications
  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / pathology*
  • Biopsy / methods
  • Databases, Factual*
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / epidemiology
  • Esophageal Neoplasms / pathology
  • Esophagoscopy / methods
  • Esophagus / pathology
  • Female
  • Humans
  • Male
  • Medical Audit / methods*
  • Metaplasia / pathology
  • Middle Aged
  • Population Surveillance / methods
  • Precancerous Conditions / diagnosis
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / pathology
  • Prevalence
  • Retrospective Studies