Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2016; 22(48): 10592-10600
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10592
Risk stratification for malignant progression in Barrett’s esophagus: Gender, age, duration and year of surveillance
Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson
Piers Gatenby, Santanu Bhattacharjee, Christine Wall, Christine Caygill, Anthony Watson, United Kingdom Barrett’s Oesophagus Registry, UCL, NW32QG London, United Kingdom
Piers Gatenby, Regional Oesophagogastric Unit, Royal Surrey County Hospital, Guildford, GU2 7XH Surrey, United Kingdom
Piers Gatenby, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, GU2 7XH Surrey, United Kingdom
Piers Gatenby, Division of Surgery and Interventional Science, UCL, Royal Free Campus, NW32QG London, United Kingdom
Author contributions: All authors contributed to this manuscript with writing, designing, and final approval.
Supported by The Barrett’s Oesophagus Campaign; The Wexham Gastrointestinal Trust; The Childwick Trust, The R. L. St J. Harmsworth Memorial Research Fund; and The David and Frederick Barclay Foundation.
Conflict-of-interest statement: None declared, the authors confirm that we have no financial arrangements related to the research or manuscript preparation to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Piers Gatenby, MA MD FRCS, Division of Surgery and Interventional Science, UCL, Royal Free Campus, Pond Street, NW32QG London, United Kingdom.
Telephone: +44-20-76792000
Received: July 18, 2016
Peer-review started: July 20, 2016
First decision: September 20, 2016
Revised: October 17, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 28, 2016

To clarify risk based upon segment length, diagnostic histological findings, patient age and year of surveillance, duration of surveillance and gender.


Patients registered with the United Kingdom Barrett’s Oesophagus Registry from 9 United Kingdom centers were included. The outcome measures were (1) development of all grades of dysplasia; (2) development of high-grade of dysplasia or adenocarcinoma; and (3) development of adenocarcinoma. Prevalent cases and subjects with < 1 year of follow-up were excluded. The covariates examined were segment length, previous biopsy findings, age at surveillance, duration of surveillance, year of surveillance and gender.


One thousand and one hundred thirty six patients were included (total 6474 patient-years). Fifty-four patients developed adenocarcinoma (0.83% per annum), 70 developed high-grade dysplasia/adenocarcinoma (1.1% per annum) and 190 developed any grade of dysplasia (3.5% per annum). High grade dysplasia and adenocarcinoma increased with age and duration of surveillance. The risk of low-grade dysplasia development was not dependent on age at surveillance. Segment length and previous biopsy findings were also significant factors for development of dysplasia and adenocarcinoma.


The risk of development of low-grade dysplasia is independent of age at surveillance, but high-grade dysplasia and adenocarcinoma were more commonly found at older age. Segment length and previous biopsy findings are also markers of risk. This study did not demonstrate stabilisation of the metaplastic segment with prolonged surveillance.

Keywords: Dysplasia, Barrett’s esophagus, Esophageal neoplasms, Public health, Epidemiology, Surveillance

Core tip: Current surveillance guidelines for Barrett’s oesophagus base the enrolment into surveillance and surveillance interval on segment length, presence or absence of intestinal metaplasia and dysplasia. This study demonstrates the importance of age as an important risk factor for high-grade dysplasia and adenocarcinoma development and that stabilisation of the epithelium does not reliably occur at long-term follow-up.