Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2019; 25(24): 3069-3078
Published online Jun 28, 2019. doi: 10.3748/wjg.v25.i24.3069
Clinical characteristics of young patients with early Barrett’s neoplasia
Yugo Iwaya, Yuto Shimamura, Kenichi Goda, Enrique Rodríguez de Santiago, John Gerard Coneys, Jeffrey D Mosko, Gabor Kandel, Paul Kortan, Gary May, Norman Marcon, Christopher Teshima
Yugo Iwaya, Yuto Shimamura, John Gerard Coneys, Jeffrey D Mosko, Gabor Kandel, Paul Kortan, Gary May, Norman Marcon, Christopher Teshima, Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
Kenichi Goda, Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan
Enrique Rodríguez de Santiago, Department of Gastroenterology, Ramón y Cajal university hospital, Madrid 28034, Spain
Author contributions: All authors helped to perform the research; Iwaya Y, Shimamura Y, Goda K, Coneys JG, Mosko JD, Kandel G, Kortan P, May G, Marcon N and Teshima C contribution to writing the manuscript; Shimamura Y, Goda K, Rodríguez de Santiago E and Teshima C contribution to drafting conception and design; Iwaya Y contribution to performing procedures; Iwaya Y and Rodríguez de Santiago E contribution to data analysis; Coneys JG, Mosko JD, Kandel G, Kortan P, May G and Marcon N contribution to performing experiments; all the authors have approved the final draft submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of St. Michael’s Hospital, University of Toronto.
Informed consent statement: Written informed consents for the upper GI endoscopy and their inclusion in our database were obtained from all participants.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that 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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yugo Iwaya, MD, PhD, Doctor, Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto M5B 1W8, Ontario, Canada. yiwaya@shinshu-u.ac.jp
Telephone: +1-416-864-3092
Received: April 1, 2019
Peer-review started: April 1, 2019
First decision: April 30, 2019
Revised: May 7, 2019
Accepted: May 18, 2019
Article in press: May 18, 2019
Published online: June 28, 2019
ARTICLE HIGHLIGHTS
Research background

Older age is one of the most important risk factors for Barrett’s esophagus. Most guidelines set the cut-off at age 50. On the other hand, the diagnosis of Barrett’s neoplasia in younger patients is becoming more common in daily clinical practice.

Research motivation

The clinical characteristics of these younger esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) patients are poorly known. If this younger cohort differs significantly with respect to specific clinical characteristics from the more typical age category of Barrett’s neoplasia, these features could help to improve screening recommendations.

Research objectives

To identify factors associated with the development of Barrett’s neoplasia occurring in younger patients.

Research methods

A retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017 was conducted. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia) were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients.

Research results

Four hundred fifty patients with T1 EAC and HGD were enrolled in this study. Forty-five patients (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to have ongoing gastroesophageal reflux disease (GERD) symptoms and to be obese. The same pattern of differences was maintained with an even greater magnitude of effects on multivariate analysis. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo).

Research conclusions

We identified that patients ≤ 50 years old with early-stage EAC or HGD had greater odds of having ongoing GERD symptoms and to be obese than older patients. Our results may serve to improve the selection of younger patients who would most benefit from screening endoscopy.

Research perspectives

Further prospective studies are needed to clarify the risk factors specific to young patients with Barrett’s-related neoplasia.