Patiënten met hooggradige dysplasie in Barrett-slokdarm*

Objective

To analyse the follow-up strategies in a Dutch cohort of patients with high-grade dysplasia (HGD) in Barrett’s oesophagus, and to identify risk factors for adenocarcinoma of the oesophagus.

Design

Retrospective cohort study.

Method

Patients with Barrett’s oesophagus in whom the diagnosis HGD had been made in the period between 1999 and 2008 were identified in PALGA, a Dutch nationwide database containing histopathology and cytopathology outcomes. Independent predictors for adenocarcinoma occurring in the first 6 months of the HGD diagnosis (prevalent adenocarcinoma) or thereafter (incident adenocarcinoma) were identified using multivariate Cox regression analysis.

Results

A total of 827 patients with Barrett’s oesophagus with HGD were included. Follow-up data from 699 patients (85%) were available. In 249 (36%) of these patients with HGD, adenocarcinoma had been established. The following circumstances were associated with a decreased risk of prevalent adenocarcinoma (n = 177): participation in an endoscopic follow-up programme prior to HGD, unifocal HGD, HGD being diagnosed at an academic hospital, and endoscopic resection or ablation of HGD. Patients between 65 and 75 years of age were associated with an increased risk. The risk of progression to incident adenocarcinoma (n = 72) was lower when patients participated in a follow-up programme after having been diagnosed with HGD and when ablation of HGD had been performed; the risk was higher at ≥ 75 years of age and when the interval between the diagnosis of HGD and the first follow-up endoscopy was longer.

Conclusion

In this Dutch cohort, the risk of adenocarcinoma was lower when patients with Barrett’s oesophagus participated in an endoscopic follow-up programme before the diagnosis of HGD was made, and who underwent endoscopic treatments; the risk was higher in the older patient.

Conflict of interest and financial support: a disclosure form, provided by the author, is available together with the full text of this article at www.ntvg.nl, search for A5056.