Abstract / Summary
Background: Surveillance recommendations for Barrett esophagus (BE) are based on BE length, since the risk of progression to dysplasia or esophageal adenocarcinoma (EAC) has been shown to increase with greater BE length. The 2023 European Society for Gastrointestinal Endoscopy (ESGE) Guideline on BE advises referral to Barrett expert centers (BECs) for surveillance of ultra-long ( ≥ 10 cm) BE. This study evaluated the outcomes of expert care for patients with ultra-long BE in the Netherlands.
Methods: This retrospective, nationwide cohort study including patients referred with ultra-long nondysplastic BE (NDBE) to Dutch BECs. Outcome parameters were number of cases upgraded to dysplasia/esophageal adenocarcinoma (EAC) at expert endoscopic reassessment, and number of cases with progression to high-grade dysplasia (HGD)/EAC during surveillance after a confirmed diagnosis of NDBE at expert endoscopic reassessment.
Results: 168 patients were referred with ultra-long NDBE, namely with Barrett length (median and interquartile range [IQR]), circumference (C) 11 cm (9-12), maximum (M) 12 cm (10-14). Upon expert endoscopic reassessment, 28 /168 (17 %) patients were diagnosed with dysplasia/EAC, among whom 5 /168 (3 %) had HGD/EAC in a visible lesion. In 11 patients no Seattle protocol biopsies were obtained, thus 129 patients had an NDBE diagnosis based on Seattle protocol biopsies. Of these, 95 /129 (74 %) had > 1 surveillance endoscopy at the BEC. During surveillance 20 patients progressed to LGD (n = 11, 12 %), HGD (n = 4, 4 %) or EAC (n = 5, 5 %); all progressors underwent endoscopic therapy.
Conclusion: Expert care with dedicated BE endoscopy programs and experienced endoscopists may be beneficial for patients with ultra-long BE.