Long term follow up of dysplasia in patients with short segment Barrett's esophagus (SSBE)

Short segments of intestinal metaplasia in the distal esophagus are being recognized with increasing frequency. Both long and short segments of Barren's esophagus can progress to dysplasia and cancer. However, the relative risk of SSBE for the development of dysplasia and adenocarcinoma of the esophagus is not yet known. Aim: To determine the frequency of development of dysplasia in patients with SSBE. Methods: Patients with SSBE were followed prospectively for the development of dysplasia. SSBE was defined as <3 cm of Barren's appearing epithelium above the gastroesophageal junction at endoscopy with intestinal metaplasia on biopsy documented by alcian blue stain at pH 2.5. Patients had interval upper endoscopy with systematic biopsy of the Barren's segment. Results: Fifty-nine patients with SSBE were identified from a cohort of 285 patients with Barren's esophagus. The mean length of Barren's mucosa in those with SSBE was 1.5±0.1 cm; the mean age of the patients was 63.1±1.3 years. Five patients had low grade dysplasia (LGD) at the initial endoscopy (prevalence 8.5%); none had high grade dysplasia (HGD). Thirty-one patients had follow up endoscopy over a mean period of 36.9±5.4 months. Five of these patients developed dysplasia on follow up; 4 with LGD and 1 with HGD (incidence of any dysplasia 5.2% per year). Of the 10 patients with dysplasia identified during the study, 8 have had a follow up endoscopy. Eqution present it. Conclusions: SSBE accounted for 20.7% of our patients with Barrett's esophagus. The prevalence of dysplasia was 8.5% with an incidence of 5.2% per year in this group of SSBE patients followed prospectively. Although dysplastic changes may not be identified on follow up examination, some patients may progress to adenocarcinoma. Therefore, we recommend surveillance endoscopy and biopsy in patients with SSBE as in those with long segment Barrett's esophagus.