Low incidence of adenocarcinoma and high-grade intraepithelial neoplasia in patients with Barrett's esophagus: a prospective cohort study

Endoscopy. 2008 Sep;40(9):711-6. doi: 10.1055/s-2008-1077502. Epub 2008 Aug 12.


Background and study aims: Barrett's esophagus is a premalignant condition. The risk of developing high grade intraepithelial neoplasia (HGIN) or adenocarcinoma is currently a matter of debate. Due to several shortcomings, previous studies have probably overestimated the risk. The main aim of our study was to investigate the incidence of HGD and adenocarcinoma in a cohort of patients with Barrett's esophagus.

Patients and methods: In a prospective, cohort study, all patients had intestinal metaplasia and macroscopic evidence of short- or long-segment (< 3 cm or > or = 3 cm) Barrett's esophagus. All patients underwent a standard protocol including regular endoscopies with biopsies and were treated with a proton pump inhibitor or antireflux surgery.

Results: A total of 135 patients underwent 623 endoscopies during 700 patient-years (mean follow-up 5.2 +/- 2.3 years). Simultaneous HGIN and adenocarcinoma were detected in two patients with long-segment Barrett's esophagus (1.5%; 2 and 6 years after the index endoscopy). Low grade intraepithelial neoplasia (LGIN) was detected in 25 patients (18.5%); in 11 of these patients (44%), LGIN was not confirmed in later biopsies. Our study shows an incidence of HGIN/adenocarcinoma of 1/350 patient-years. Endoscopic regression of Barrett's esophagus was seen in 20.7% of patients.

Conclusion: The incidence of HGIN/adenocarcinoma is low in patients with adequately treated Barrett's esophagus. The annual risk of developing HGIN/adenocarcinoma is 0.21% (1.6% in long-segment Barrett's esophagus).

MeSH terms

  • Adenocarcinoma / epidemiology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / epidemiology*
  • Carcinoma in Situ / epidemiology*
  • Cohort Studies
  • Comorbidity
  • Endoscopy
  • Female
  • Helicobacter Infections / epidemiology
  • Helicobacter pylori
  • Hernia, Hiatal / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Assessment