DYSPLASIA IN SHORT-SEGMENT BARRETTS-ESOPHAGUS - A PROSPECTIVE 3-YEAR FOLLOW-UP

Objective: Short segments of intestinal metaplasia in the distal esoph agus are being recognized with increasing frequency. Both long and sho rt segments of Barrett's esophagus can progress to dysplasia and cance r, However, the risk of short-segment Barrett's esophagus (SSBE) for t he development of dysplasia and adenocarcinoma of the esophagus is not yet known. Our purpose, therefore, was to determine the frequency wit h which dysplasia occurs in patients with SSBE. Methods: Patients with SSBE were followed prospectively for the development of dysplasia. SS BE was defined as < 3 cm of Barrett's-appearing epithelium above the g astroesophageal junction at endoscopy, with intestinal metaplasia on b iopsy as documented by alcian blue stain at pH 2.5 on at least two end oscopic biopsies 6 months apart. Patients had interval upper endoscopy with systematic biopsy of the Barrett's segment. Results: Fifty-nine SSBE patients were identified, The mean length of Barrett's mucosa was 1.5 +/- 0.1 cm; the mean age of the patients was 63.1 +/- 1.3 Sr, Fiv e patients had low grade dysplasia (LGD) at initial endoscopy, for a p revalence of 8.5%; none had high grade dysplasia (HGD). Thirty-two pat ients had follow-up endoscopy over a mean period of 36.9 +/- 5.4 month s. Five of these patients developed dysplasia on follow-up, three with LGD and two with HGD, the incidence of any dysplasia being 5.7% per y ear. One patient with HGD that developed during surveillance progresse d to adenocarcinoma of the esophagus over a 2-yr period. The other pat ient with I-IGD had LGD on follow-up endoscopy. Six patients with init ial LGD had no evidence of dysplasia on follow-up, Conclusions: The pr evalence of dysplasia was 8.5% with am incidence of 5.7% per year in t his group of SSBE patients, followed prospectively. Although dysplasti c changes may not be identified on follow-up examination, some patient s progress to adenocarcinoma. Therefore, we recommend surveillance end oscopy and biopsy in patients with SSBE just as in those with long-seg ment Barrett's esophagus.