B0206 - The Prevalence of Dysplasia in Ultrashort Barrett's Esophagus in a United States Veteran Population

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ronan Allencherril, MD

Baylor College of Medicine
Houston, TX

Ronan Allencherril, MD, Theresa Nguyen Wenker, MD, MPH, Gyanprakash A. Ketwaroo, MD, MSc, Rollin George, MD, Aaron Thrift, PhD, Hashem El-Serag, MD, MPH
Baylor College of Medicine, Houston, TX

Introduction: Surveillance of Barrett’s esophagus (BE), the only known precursor to esophageal adenocarcinoma (EA), is the basis for secondary prevention of EA. Length of BE has been associated with EA risk, and current guidelines recommend against biopsies of ultrashort BE (i.e., BE length < 1cm), however this is based on limited evidence. Our study aims to characterize the prevalence of dysplasia in ultrashort BE.

Methods: We conducted a retrospective cohort study at the Houston VA of consecutive patients with new BE diagnosis from 11/1990-1/2019 with follow-up through 12/2021. We classified ultrashort BE as length < 1cm at initial BE-diagnosing (index) EGD. We defined persistent ultrashort BE as those with ultrashort BE on index EGD and all follow-up EGDs through the entire study period, requiring 2 or more EGDs. We calculated the prevalence of any dysplasia (indefinite [IND], low-grade [LGD], and high-grade [HGD]) and definite dysplasia (LGD and HGD). We examined the association of age, race, gender, body mass index (BMI), smoking history, and alcohol history with dysplasia in ultrashort BE and BE ≥1cm with chi-square test.

Results: Our cohort had 741 patients with BE. The mean follow-up time was 4.6 years (standard deviation, 5.5 years). Ultrashort BE was present in 20.2% (n=150) of BE patients. Of the 150 with ultrashort BE, 131 underwent at least two EGDs. Persistent ultrashort BE was present in 92 patients with BE (12.4%). The prevalence of any dysplasia and definite dysplasia were 24.0% (n=36, 29 IND, 2 LGD, 5 HGD) and 4.7% (n=7) among those with ultrashort BE, and 52.6% and 23.8% respectively among those with BE ≥1cm. Of those with ultrashort BE, 4 (2.7%) developed any dysplasia after the index EGD. Of those with persistent ultrashort BE, the prevalence of any dysplasia was 21.7% (n=20, 16 IND, 2 LGD, 2 HGD), while the prevalence of definite dysplasia was 4.4% (n=4). All cases of dysplasia in persistent ultrashort BE were diagnosed at the index EGD. Normal BMI was associated with any dysplasia among those with ultrashort BE (p-value 0.003), while non-Hispanic White race/ethnicity was associated with any dysplasia among those without ultrashort BE (p-value 0.009; Table 1).

Discussion: While the prevalence of dysplasia is lower than that for BE ≥1cm, the prevalence of dysplasia in ultrashort BE in this study was as high as 24.0%. These patients may not be safely excluded from surveillance. Further studies should be conducted to confirm these findings.

	Ultrashort BE < 1cm at Index EGD			BE ≥1cm at Index EGD
	No Dysplasia N=114 N (%)	Any dysplasia N = 36 N (%)	p-value	No Dysplasia N = 280 N (%)	Any Dysplasia N = 311 N (%)	p-value
Age
< 60 years	45 (39.5%)	9 (25.0%)	0.115	94 (33.6%)	104 (33.4%)	0.973
60+ years	69 (60.5%)	27 (75.0%)		186 (66.4%)	207 (66.6%)
Sex
Male	106 (93.0%)	34 (94.4%)	0.759	269 (96.1%)	304 (98.1%)	0.147
Female	8 (7.0%)	2 (5.6%)		11 (3.9%)	6 (1.9%)
Race
Non-Hispanic White	86 (75.4%)	26 (72.2%)	0.47	216 (77.1%)	264 (85.9%)	0.009
African American	17 (14.9%)	4 (11.1%)		36 (12.9%)	16 (5.1%)
Hispanic	11 (9.7%)	6 (16.7%)		26 (9.3%)	30 (9.7%)
Other/Missing	0 (0.0%)	0 (0.0%)		2 (0.7%)	1 (0.3%)
BMI Categories
Normal (< 25)	18 (15.8%)	11 (30.6%)	0.003	52 (18.6%)	51 (16.4%)	0.878
Overweight (25-29.9)	38 (33.3%)	18 (32.1%)		106 (37.9%)	126 (40.5%)
Obese (30+)	58 (50.9%)	7 (19.4%)		120 (42.9%)	132 (42.4%)
Missing	0 (0.0%)	0 (0.0%)		2 (0.7%)	2 (0.6%)
Smoking
Never Smoker	29 (25.4%)	8 (22.2%)	0.813	78 (27.9%)	83 (26.7%)	0.429
Former Smoker	59 (51.8%)	18 (50.0%)		121 (43.2%)	150 (48.2%)
Current Smoker	26 (22.8%)	10 (27.8%)		81 (28.9%)	78 (25.1%)
Alcohol Use
Never Alcohol use	36 (31.6%)	12 (33.3%)	0.862	128 (45.7%)	115 (37.0%)	0.088
Former Alcohol Use	28 (24.6%)	10 (27.8%)		58 (20.7%)	70 (22.5%)
Current Alcohol Use	50 (43.9%)	14 (38.9%)		94 (33.6%)	126 (40.5%)

Abbreviations: BE (Barrett's esophagus), cm (centimeter), BMI (body mass index)

Table: Table 1. Sociodemographic and clinical characteristics of any dysplasia (indefinite for dysplasia, low-grade dysplasia, and high-grade dysplasia) among those with and without ultrashort Barrett’s esophagus.

Disclosures:

Ronan Allencherril indicated no relevant financial relationships.

Theresa Nguyen Wenker indicated no relevant financial relationships.

Gyanprakash Ketwaroo indicated no relevant financial relationships.

Rollin George indicated no relevant financial relationships.

Aaron Thrift indicated no relevant financial relationships.

Hashem El-Serag indicated no relevant financial relationships.

Ronan Allencherril, MD, Theresa Nguyen Wenker, MD, MPH, Gyanprakash A. Ketwaroo, MD, MSc, Rollin George, MD, Aaron Thrift, PhD, Hashem El-Serag, MD, MPH. B0206 - The Prevalence of Dysplasia in Ultrashort Barrett's Esophagus in a United States Veteran Population, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.