Su1116 US VETERANS WITH PERSISTENT INDEFINITE FOR DYSPLASIA ARE AT INCREASED RISK OF DYSPLASTIC PROGRESSION

Barrett’s esophagus (BE) is a risk factor for esophageal adenocarcinoma (EAC) that requires surveillance for advancing degrees of dysplasia with associated increase risk of malignant progression. To date, the incidence of malignant progression in patients with indefinite for dysplasia (IND) is incompletely characterized in both the general and US veteran population. To characterize the incidence of progression to advanced neoplasia and determine contributing risk factors in US veterans with BE-IND. All patients with BE-IND were identified at the Minneapolis Veterans Affairs Health Care System between January 2006 and December 2016. A diagnosis of IND was established by consensus of 2 to 7 pathologists including an expert GI pathologist. Demographic information, past medical history, EGD findings, histopathology and lifestyle risk factors were collected. Evidence of persistent IND was defined as IND on subsequent endoscopy greater than 3 months after initial diagnosis. The primary endpoint of the study was the development of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). Univariate logistic regression analysis was used to assess the association between outcomes and risk factors for neoplastic progression. A Kaplan-Meier curve was used to evaluate progression-free survival then compared using Log-rank test. Among 109 patients with BE-IND, 23 (21%) developed LGD, 2 (1.8%) developed HGD and 2 (1.8%) developed EAC during a median follow up of 2.39 years (interquartile range, 1.13-5.17). The overall (persistent and non-persistent IND) incidence of progression to LGD/HGD/EAC and HGD/EAC were 4.65 (95% confidence interval [CI], 2.88-7.12) and 0.98 (95% CI, 0.3-2.3) cases per 100 patient years respectively. When considering only patients with persistent IND, the incidence of progression to LGD/HGD/EAC and HGD/EAC was 9.84 (95% CI, 5.08 - 17.19) and HGD/EAC was 3.28 (95% CI, 0.98 to 5.02) cases per 100 patient years respectively. There was a 5-fold increase risk of any dysplasia progression (odds ratio 4.99 (95% CI, 1.73-14.38) when IND was persistent. All patients with progression to HGD/EAC had persistent IND (n = 4). The Kaplan-Meier curve for progression-free survival between persistent and non-persistent IND (P = 0.001) is shown in Figure 1. Other traditional risk factors, including obesity, length of BE, and tobacco use were not significantly associated with progression (Table 1). Among US veterans, the risk of progression in HGD/EAC in patients with BE-IND is similar to accepted rates of progression for non-dysplastic BE. However, persistent BE-IND carries a 5-fold increase risk of dysplastic progression. Our data also suggest persistent BE-IND may be associated with increased risk of progression to HGD/EAC. Future studies should focus on the risk associated with persistent IND.Tabled 1Table 1. Demographic and clinicopathological factors associated with the progression of INDParameterNon-Progressors (n=90)Progressors (n=19)P-valueAge (years)65.0265.680.75Obesity (Body Mass Index > 30)44/8912/190.27Persistence of IND23/9012/190.001Hiatal hernia63/8816/190.25Alcohol use20/903/190.53Tobacco use66/9011/190.18Diabetes Mellitus22/908/190.12Cirrhosis2/901/190.46Gastroesophageal reflux disease73/9016/190.75Long Segment BE37/7311/190.58(Categorical variables were summarized as count and proportion and compared using Fisher’s exact test. Continuous variables were summarized as median and compared using Two sample t-test). Open table in a new tab