Extent of high-grade dysplasia in Barrett's esophagus correlates with riskof adenocarcinoma

(Background & Aims) under bar: The identification of any high-grade dysplas ia (HGD) in Barrett's esophagus has been considered to be an indication for esophagectomy because of the increased risk of cancer, The aim of this stu dy was to determine if a limited extent of HGD has the same potential for c ancer as diffuse HGD. (Methods) under bar: A retrospective cohort study was performed to assess the risk of developing adenocarcinoma in relationship to the extent of HGD found on endoscopic surveillance. The extent of HGD wa s defined as focal if cytologic and/or architectural changes of HGD were li mited to a single focus of 5 or fewer crypts and diffuse if more than 5 cry pts were involved in a single biopsy specimen or if HGD involved more than one biopsy fragment. The relative risk of cancer was assessed using a Cox p roportional hazard model, and cancer-free survival was determined using sur vival curves. (Results) under bar: Sixty-seven patients with diffuse HGD an d 33 with focal HGD satisfied selection criteria. Cancer-free survival rate s at 1 and 3 years were 93% and 86% for focal HGD compared with 62% and 44% for diffuse HGD (P < 0.001), On univariate analysis, extent of HGD (relati ve risk, 5.36; 95% confidence interval, 1.84-15.56), nodularity on endoscop y (relative risk, 3.98; 95% confidence interval, 1.97-8.04), and lack of ac id suppression (relative risk, 2.48; 95% confidence interval, 1.16-5.28) we re associated with an increased risk of esophageal adenocarcinoma. Diffuse HGD had a 3.7-fold increase in the risk of esophageal cancer compared with focal HGD (P = 0.02) on multivariate analysis. <(Conclusions)under bar>: Pa tients with focal HGD are less likely to have cancer during the first year after diagnosis or on subsequent follow-up compared with diffuse HGD.