Does risk of progression from Barrett’s esophagus to esophageal adenocarcinoma change based on the number of non-dysplastic endoscopies?

Andrew T Kunzmann* (Corresponding Author), Helen G Coleman, Brian T Johnston, Richard C. Turkington, Damian McManus, Lesley Anderson, Aaron P. Thrift

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Background: There is a large Barrett’s esophagus patient population undergoing endoscopic surveillance. Methods to stratify patients into higher and lower risk groups may enable more varied surveillance intervals for patients with non-dysplastic Barrett’s esophagus that could optimise use of endoscopy resources.
Objective: We aimed to assess whether risk of progression to esophageal adenocarcinoma differed in patients with multiple endoscopic biopsies negative for dysplasia.
Methods: We conducted a retrospective cohort study among individuals from the population-based Northern Ireland Barrett’s register with a histologically confirmed diagnosis of non-dysplastic Barrett’s esophagus (with intestinal metaplasia) between 1993 and 2010, who had at least one endoscopic biopsy conducted at least 12 months after diagnosis. We used Poisson regression to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for the association between number of successive endoscopies showing non-dysplastic Barrett’s esophagus and risk of esophageal adenocarcinoma alone, and combined with high-grade dysplasia, at the next endoscopy.
Results: We identified 1,761 individuals who met our eligibility criteria. Subsequent risk of progression to esophageal adenocarcinoma was lower at the next endoscopy following two endoscopies showing non-dysplastic Barrett’s esophagus (IRR 0.26, 95% CI 0.10-0.66) than following one endoscopy showing non-dysplastic Barrett’s esophagus. Similar findings were apparent for risk of progression to esophageal adenocarcinoma or high-grade dysplasia (IRR 0.41, 95% CI 0.22-0.79).
Conclusion: The lower risk of malignant progression in individuals with persistent non-dysplastic Barrett’s esophagus over two consecutive endoscopic biopsies but not for longer term persistence does not support hypotheses of persistence being an indicator of less biologically aggressive lesions. Instead, the initial difference may be attributable to post-endoscopy cancers and support the necessity of adhering to robust quality standards for endoscopic procedures.
Original languageEnglish
Pages (from-to)1965–1973
Number of pages9
JournalDigestive Diseases and Sciences
Early online date20 Jul 2020
Publication statusPublished - Jun 2021

Bibliographical note

Funding: This study was funded in full by the National Institutes of Health, grant number (NIH P30DK056338‐16). The Northern Ireland Barrett’s register was funded by the UK Medical Research Council, Cancer Focus Northern Ireland (formerly the Ulster Cancer Foundation), NI HSC R&D Office, and Cancer Research UK. The Northern Ireland Cancer Registry is funded by the Public Health Agency.


  • Barrett’s esophagus
  • Endoscopic surveillance
  • Epidemiology
  • Esophageal adenocarcinoma
  • Barrett's esophagus


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