Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2018; 24(39): 4472-4481
Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4472
Barrett’s esophagus with high grade dysplasia is associated with non-esophageal cancer
Nir Bar, Naama Schwartz, Michal Nissim, Naomi Fliss-Isacov, Shira Zelber-Sagi, Revital Kariv
Nir Bar, Naama Schwartz, Michal Nissim, Naomi Fliss-Isacov, Shira Zelber-Sagi, Revital Kariv, Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 6423906, Israel
Nir Bar, Naama Schwartz, Michal Nissim, Naomi Fliss-Isacov, Revital Kariv, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
Shira Zelber-Sagi, School for Public Health, University of Haifa, Haifa 31905, Israel
Author contributions: Kariv R designed the study; Nissim M and Bar N collected the data; Schwartz N, Fliss-Isakov N and Bar N did the statistical analysis; Bar N, Kariv R, and Zelber-Sagi S prepared the manuscript; Bar N, Kariv R, Zelber-Sagi S, Fliss-Isacov N and Schwartz N critically reviewed the manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Review board (protocol number 0022-09).
Informed consent statement: Informed consent was waivered by the Institutional review board.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Revital Kariv, MD, Doctor, Department of Gastroenterology, Tel Aviv Medical Center, Weitzman 6 street, Tel Aviv 6423906, Israel.
Telephone: +972-3-6974458 Fax: +972-3-6974868
Received: July 30, 2018
Peer-review started: July 30, 2018
First decision: August 27, 2018
Revised: September 3, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018

To study factors associated with esophageal and non-esophageal cancer morbidity among Barrett’s esophagus (BE) patients.


A cohort study within a single tertiary center included 386 consecutive patients with biopsy proven BE, who were recruited between 2004-2014. Endoscopic and histologic data were prospectively recorded. Cancer morbidity was obtained from the national cancer registry. Main outcomes were BE related (defined as esophagus and cardia) and non-BE related cancers (all other cancers). Cancer incidence and all-cause mortality were compared between patients with high-grade dysplasia (HGD) and with low-grade or no dysplasia (non-HGD) using Kaplan-Meier curves and cox regression models.


Of the 386 patients, 12 had HGD, 7 had a BE related cancer. There were 75 (19.4%) patients with 86 cases of lifetime cancers, 76 of these cases were non-BE cancers. Seven (1.8%) and 18 (4.7%) patients had BE and non-BE incident cancers, respectively. Twelve (3.1%) patients had HGD as worst histologic result. Two (16.7%) and 16 (4.4%) incident non-BE cancers occurred in the HGD and non-HGD group, respectively. Ten-year any cancer and non-BE cancer free survival was 63% and 82% in the HGD group compared to 93% and 95% at the non-HGD group, respectively. Log-rank test for patients with more than one endoscopy, assuring longer follow up, showed a significant difference (P < 0.001 and P = 0.017 respectively). All-cause mortality was not significantly associated with BE HGD.


Patients with BE and HGD, may have a higher risk for all-cause cancer morbidity. The implications on cancer prevention recommendations should be further studied.

Keywords: Barrett’s esophagus, High grade dysplasia, Esophageal cancer, Upper endoscopy, Cancer morbidity

Core tip: Barrett’s esophagus (BE) is known to be associated with esophageal carcinoma (EAC) and increased all cause and cancer specific mortality, but EAC is responsible only for a minority of BE mortality cases. We found patients with high-grade dysplasia to be more prone to non-BE related cancers, on top of BE related cancers. Such information can affect the recommended extraesophageal surveillance, and contribute the debate about the cost-effectiveness of endoscopic surveillance and to health systems decision making.