'Missed' oesophageal adenocarcinoma and high-grade dysplasia in Barrett's oesophagus patients: A large population-based study. Issue 4 (May 2018)

• Record Type: Journal Article
• Authors: van Putten, Margreet; Johnston, Brian T; Murray, Liam J; Gavin, Anna T; McManus, Damian T; Bhat, Shivaram; Turkington, Richard C; Coleman, Helen G
• Is Part Of: United European Gastroenterology journal. Volume 6:Issue 4(2018)
• Page Start: 519
• Page End: 528
• Publication Date: 2018-05
• Subjects: Barrett's oesophagus -- oesophageal cancer -- endoscopy -- surveillance -- population-based; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640617737466
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: A systematic review suggests that 25% of oesophageal adenocarcinomas (OAC) are 'missed' at index endoscopy for Barrett's oesophagus (BO); however, this included few population-based studies and may be an overestimate. Objective: The objective of this article is to quantify the 'missed' rates of high-grade dysplasia (HGD) and OAC at index BO endoscopy. Methods: Patients from the Northern Ireland BO register diagnosed between 1993 and 2010 ( n = 13, 159) were linked to the Northern Ireland Cancer Registry to identify patients who developed OAC or HGD. Logistic regression analysis compared characteristics of 'missed' vs 'incident' HGD/OAC, defined as diagnoses within 3–12 months vs >1 year after incident BO, respectively. Results: A total of 267 patients were diagnosed with HGD/OAC ≥3 months after BO diagnosis, of whom 34 (12.7%) were potentially 'missed'. The proportion of 'missed' HGD/OAC was 25% among BO patients with low-grade dysplasia (LGD) and 9% among non-dysplastic BO patients. Older age and BO-LGD carried a higher risk of 'missed' HGD/OAC. Non-dysplastic BO patients were more often diagnosed with a 'missed' OAC (rather than HGD; 89%), compared with BO-LGD patients (40%). Conclusions: Approximately one in 10 HGD/OAC cases are 'missed' at incident BO diagnosis, which is significant but lower than previous reports. However, 'missed' HGD/OAC cases represent only 0.26% of all BO patients.