Routinely diagnosed low‐grade dysplasia in Barrett’s oesophagus: a population‐based study of natural history

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Abstract
Aims:  To examine the natural history of columnar‐lined oesophagus with routinely diagnosed low‐grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development.Methods and results:  A multicentre retrospective cohort study of 283 patients with low‐grade dysplasia. Follow‐up data were obtained from examination of hospital records. One hundred and forty‐four patients had biopsies prior to low‐grade dysplasia diagnosis and 217 had follow‐up biopsies after index low‐grade dysplasia diagnosis. In these patients the incidence of high‐grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow‐up, 43 (19.8%) had persistent low‐grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non‐dysplastic columnar‐lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low‐grade dysplasia diagnosis), the annual incidence of high‐grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low‐grade dysplasia compared with non‐dysplastic columnar‐lined oesophagus was 2.871 (P = 0.002).Conclusions:  Low‐grade dysplasia has a threefold increased risk of progression to cancer compared with non‐dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.

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