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

Margreet van Putten, Brian T Johnston, Liam J Murray, Anna T Gavin, Damian T McManus, Shivaram Bhat, Richard C Turkington, Helen G Coleman

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7 Citations (Scopus)
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Abstract

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.

Original languageEnglish
Pages (from-to)519-528
Number of pages10
JournalUnited European Gastroenterology Journal
Volume6
Issue number4
Early online date11 Oct 2017
DOIs
Publication statusPublished - 01 May 2018

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