Incidence rates of Barrett’s esophagus and esophageal adenocarcinoma: a systematic review and meta-analysis

Abstract

Background and Aims

Barrett’s esophagus (BE) surveillance is commonly performed to detect early dysplasia and esophageal adenocarcinoma (EAC). However, high-quality incidence rates for the development of dysplasia and EAC in patients with BE are limited. The aim of this study was to perform a systematic review and meta-analysis to provide updated incidence rates for the development of low-grade dysplasia (LGD), high-grade dysplasia (HGD), and EAC in a population of patients with BE undergoing endoscopic surveillance.

Methods

We performed a systematic search of Embase and MEDLINE from inception to September 2022. The goal was to identify studies reporting the incidence rates of LGD, EAC, or HGD/EAC as an outcome in patients with nondysplastic BE (NDBE), LGD, or HGD. Respective pooled incidence rates were estimated by using a meta-analysis.

Results

Twenty-five studies were included in this meta-analysis comprising 2587 patients with a combined follow-up of 218,351 person-years. For patients with NDBE, pooled incidence rates for progression to LGD, HGD, EAC, and HGD/EAC were 4.29, .52, .21, and .57 per 100 person-years, respectively. For patients with LGD, pooled incidence rates were 3.18 (HGD), 1.16 (EAC), and 5.05 (HGD/EAC) per 100 person-years. For those with HGD, the pooled incidence rate for EAC was 14.16 per 100 person-years.

Conclusions

Progression to EAC and HGD/EAC remained low for patients with NDBE. Patients with confirmed (by ≥2 pathologists) LGD may be more likely to develop EAC, prompting a need to assess current BE surveillance strategies in this group.