Barrett's esophagus and adenocarcinoma risk: the experience of the North-Eastern Italian Registry (EBRA).

Massimo Rugge, Giovanni Zaninotto, Paola Parente, Lisa Zanatta, Francesco Cavallin, Bastianello Germanà, Ettore Macrì, Ermenegildo Galliani, Paolo Iuzzolino, Francesco Ferrara, Renato Marin, Emiliano Nisi, Gaetano Iaderosa, Michele Deboni, Angelo Bellumat, Flavio Valiante, Georgeta Florea, Duilio Della Libera, Marco Benini, Laura BortesiAlberto Meggio, Maria G. Zorzi, Giovanni Depretis, Gianni Miori, Luca Morelli, Giovanni Cataudella, Emanuele D'amore, Ilaria Franceschetti, Loredana Bozzola, Elisabetta Paternello, Cristina Antonini, Francesco Di Mario, Nadia Dal Bò, Alberto Furlanetto, Lorenzo Norberto, Lino Polese, Silvia Iommarini, Fabio Farinati, Giorgio Battaglia, Giorgio Diamantis, Stefano Realdon, Ennio Guido, Gaetano Mastropaolo, Daniele Canova, Antonello Guerini, Marilisa Franceschi, Maurizio Zirillo

Research output: Contribution to journalArticle

Abstract

To establish the incidence and risk factors for progression to high-grade intraepithelial neoplasia (HG-IEN) or Barrett's esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. In 2003, a regional registry of BE patients was created in north-east Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression. HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2-4); median follow-up = 44.6 [IQR: 24.7-60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51-68) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9-50.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63-21.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22-11.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03-1.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments.

Original languageEnglish
JournalAnnals of Surgery
Volume256
Issue number5
Publication statusPublished - Nov 2012

ASJC Scopus subject areas

  • Surgery

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    Rugge, M., Zaninotto, G., Parente, P., Zanatta, L., Cavallin, F., Germanà, B., Macrì, E., Galliani, E., Iuzzolino, P., Ferrara, F., Marin, R., Nisi, E., Iaderosa, G., Deboni, M., Bellumat, A., Valiante, F., Florea, G., Della Libera, D., Benini, M., ... Zirillo, M. (2012). Barrett's esophagus and adenocarcinoma risk: the experience of the North-Eastern Italian Registry (EBRA). Annals of Surgery, 256(5).