Barrett\u2019s Esophagus and Adenocarcinoma Risk The Experience of the North-Eastern Italian Registry (EBRA)

Objective: To establish the incidence and risk factors for progression to highgrade intraepithelial neoplasia (HG-IEN) or Barrett\u2019s esophageal adenocarcinoma (BAc) in a prospective cohort of patients with esophageal intestinal metaplasia [(BE)]. Background: BE is associated with an increased risk of BAc unless cases are detected early by surveillance. No consistent data are available on the prevalence of BE-related cancer, the ideal surveillance schedule, or the risk factors for cancer. Methods: In 2003, a regional registry of BE patients was created in northeast Italy, establishing the related diagnostic criteria (endoscopic landmarks, biopsy protocol, histological classification) and timing of follow-up (tailored to histology) and recording patient outcomes. Thirteen centers were involved and audited yearly. The probability of progression to HG-IEN/BAc was calculated using the Kaplan-Meier method; the Cox regression model was used to calculate the risk of progression.Results: HG-IEN (10 cases) and EAc (7 cases) detected at the index endoscopy or in the first year of follow-up were considered to be cases of preexisting disease and excluded; 841 patients with at least 2 endoscopies {median, 3 [interquartile range (IQR): 2\u20134); median follow-up = 44.6 [IQR: 24.7\u2013 60.5] months; total 3083 patient-years} formed the study group [male/female = 646/195; median age, 60 (IQR: 51\u201368) years]. Twenty-two patients progressed to HG-IEN or BAc (incidence: 0.72 per 100 patient-years) after a median of 40.2 (26.9\u201350.4) months. At multivariate analysis, endoscopic abnormalities, that is, ulceration or nodularity (P = 0.0002; relative risk [RR] = 7.6; 95% confidence interval, 2.63\u201321.9), LG-IEN (P = 0.02, RR = 3.7; 95% confidence interval, 1.22\u201311.43), and BE length (P = 0.01; RR = 1.16; 95% confidence interval, 1.03\u20131.30) were associated with BE progression. Among the LG-IEN patients, the incidence of HG-IEN/EAc was 3.17 patient-years, that is, 6 times higher than in BE patients without LG-IEN. Conclusions: These results suggest that in the absence of intraepithelial neoplastic changes, BE carries a low risk of progression to HG-IEN/BAc, and strict surveillance (or ablative therapy) is advisable in cases with endoscopic abnormalities, LG-IEN or long BE segments

Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU"

56nonenoneZaninotto, G; Avellini, C; Barbazza, R; Baruchello, G; Battaglia, G; Benedetti, E; Bernardi, A; Boccù, C; Bonoldi, E; Bottona, E; Bozzola, L; Canizzaro, R; Canzonieri, V; Caroli, A; Carta, A; Colonna, A; Costa-Biedo, F; Dal Bò, N; De Bastiani, R; De Bernardin, M; De Bernardinis, F; De Pretis, G; Di Mario, F; Doglioni, C; Donisi, Pm; Franceschi, M; Furlanetto, A; Germanà, B; Grassi, Sa; Macor, V; Marcon, V; Marin, R; Meggiato, T; Melina, V; Menghi, A; Milan, R; Militello, C; Molena, D; Monica, F; Murer, B; Nisi, E; Olivieri, P; Orzes, N; Parenti, A; Paternello, E; Penelli, N; Pilotto, A; Piscioli, F; Pozzato, F; Ronzani, G; Rugge, M; Saggioro, A; Stracca-Pansa, V; Togni, R; Valiante, F; Vianello, F