‘Missed’ oesophageal adenocarcinoma and high-grade dysplasia in Barrett’s oesophagus patients: A large population-based study

• Published in: United European gastroenterology journal Vol. 6; no. 4; pp. 519 - 528
• Main Authors: van Putten, Margreet, Johnston, Brian T, Murray, Liam J, Gavin, Anna T, McManus, Damian T, Bhat, Shivaram, Turkington, Richard C, Coleman, Helen G
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2018
• Subjects: Barrett's oesophagus; endoscopy; oesophageal cancer; Original; population-based; surveillance; endoscopy; surveillance; Barrett’s oesophagus; oesophageal cancer; population-based
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1177/2050640617737466

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.