Aims Barrett’s oesophagus with indefinite for dysplasia (IDD) carries a risk of prevalent and incident dysplasia and oesophageal adenocarcinoma. This study seeks to determine the risk of neoplasia in a multicentre prospective IDD cohort, along with determining adherence to British Society of Gastroenterology (BSG) guidelines for management and histology reporting.
Methods This was a cohort study using prospectively collected data from pathology databases from two centres in the North West of England (UK). Cases with IDD were identified over a 10-year period. Data were obtained on patient demographics, Barrett’s endoscopy findings and histology, outcomes and histological reporting.
Results 102 biopsies with IDD diagnosis in 88 patients were identified. Endoscopy was repeated in 78/88 (88%) patients. 12/78 progressed to low-grade dysplasia (15% or 2.6 per 100 person years), 6/78 (7.7%, 1.3 per 100 person years) progressed to high-grade dysplasia and 6/78 (7.7%, 1.3 per 100 person years) progressed to oesophageal adenocarcinoma. The overall incidence rate for progression to any type of dysplasia was 5.1 per 100 person years. Cox regression analysis identified longer Barrett’s segment, multifocal and persistent IDD as predictors of progression to dysplasia. Histology reporting did not meet 100% adherence to the BSG histology reporting minimum dataset prior to or after the introduction of the guidelines.
Conclusions IDD carries significant risk of progression to dysplasia or neoplasia. Therefore, careful diagnosis and management aided by clear histological reporting of these cases is required to diagnose prevalent and incident neoplasia.
- Barrett Esophagus
- Gastrointestinal Neoplasms
Data availability statement
Data are available upon reasonable request.
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Handling editor Runjan Chetty.
Contributors YA, MK, JB and ER were involved in the conception and design of the study. MK, ER, HY, AT and AN performed the extensive screening of the histology reports and data collection and cleaning. MK performed the statistical analysis of the data with input from ER, JB and YA. MK and ER wrote the initial draft manuscript, all authors reviewed and revised the manuscript. Final approval of the submitted manuscript was obtained from all authors. YA is the guarantor for the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests YA and ER receive research funding from Medtronic for other studies.
Provenance and peer review Not commissioned; externally peer reviewed.