IRISH SOCIETY OF GASTROENTEROLOGY
Oral Winners 2020 - Second Prize
Lisa O' Byrne
St James Hospital, Dublin, Ireland
The significance of Low Grade (LGD) and Indefinite for Dysplasia (IED) in Barrett’s Oesophagus
Lisa M. O' Byrne (1) , Marie O' Brien (1), Cian Muldoon (1), Ciara Ryan (1), Martin Buckley (2), Thomas Murphy (2), Rob Reynolds (2), Stephen Patchett (3), Elaine Kay (3), Halsema Azam (3), William Robb (3), Mayilone Arumugasamy (3), Padraic Mc Mathuna (4), Jan Leyden (4), Siobhan Gargan (4), Glen Doherty (5), Kieran Sheahan (5), Chris Collins (6), Amar Nath (6), Jacintha O’Sullivan (1), Claire L Donohoe (1), Narayanasamy Ravi (1), Dermot O' Toole (1), John V. Reynolds (1)
1. St James Hospital, Dublin, Ireland. 2. Mercy University Hospital, Cork, Ireland. 3. Beaumont Hospital, Dublin, Ireland. 4. Mater Misercordiae University Hospital, Dublin, Ireland. 5. St Vincents University Hospital, Dublin, Ireland. 6. Galway University Hospital, Galway, Ireland.
A multicentre Irish collaboration on Barrett’s oesophagus (RIBBON Network) established a Registry identify and manage patients.
The aim of this study was to characterise low grade (LGD) and indefinite for dysplasia (IED) in terms of prevalence, and progression to high grade dysplasia (HGD) or invasive adenocarcinoma (OAC).
Detailed endoscopic, pathological and clinical data was collected over 10 years. Patients were included if they had an initial of Indefinite for dysplasia (IED) or Low-Grade Dysplasia (LGD) or had an initial episode of Non Dysplastic Barrett’s Oesophagus (NDBO) with a subsequent episode of IED or LGD.
From 860 patients, with a total follow up of 3492 patient years, 252 patients had IED, 258 had LGD at diagnosis and 350 patients had NDBO initially with progression to LGD or IED. Of these, 18% progressed, with an incidence for OAC of 1.9% per year, HGD of 2.6 % per year, and a combined rate of 4.6% per year. Median time to progression in the NDBO group was 4.7 years while this was 1.1 years for IED and 9 months for LGD. Regression to NDBO occurred in 61.4% of cases.
This study revealed that almost one in twenty patients with LGD or IED progress each year to HGD or OAC, a fivefold increase compared with NDBO alone. The short duration to progression of LGD and IED at diagnosis suggests a high risk of incident cancer, highlighting the need for strict surveillance and consideration of endoscopic therapy.