Erenmalm, Hugo (2025) Low risk of neoplastic progression in patients with Barrett’s esophagus shorter than 5 cm, without dysplasia or a family history of esophageal adenocarcinoma: an update from a large community-based cohort in the Amsterdam region. thesis, Medicine.
Full text available on request.Abstract
Background: In March 2025, the Dutch national guideline for the management of patients with Barrett’s esophagus (BE) was revised. Endoscopic surveillance is no longer recommended for so-called “low-risk” patients, defined as those with a Barrett-segment length under 5 cm, without low-grade dysplasia and without first-degree family members with a history of esophageal adenocarcinoma (EAC). The discontinuation of surveillance was based on a lack of evidence that surveillance was cost-effective or led to a survival benefit in these patients, but the exact risk of progression to high-grade dysplasia (HGD) or EAC in this group is unknown. This study aims to identify the risk of progression in the low-risk group and evaluate the clinical predictors used in their definition. Method: We updated an existing cohort of 985 BE surveillance patients with a median follow-up of 7.9 years (IQR 4.1–12.5) completed by July 2017, by reviewing pathology reports and patient journals until May 2025. Results: 973 patients were included, with a median follow-up of 11.3 years per patient (IQR 6.8-15.9). Patients in the low-risk group had an annual risk of 0.32% (95% CI 0.2-0.49%) while the risk of progression across the entire cohort was 0.84% per patient-year (95% CI 0.68-1.02%). The presence of low-grade dysplasia, length of the Barrett-segment and age at index endoscopy were significant clinical predictors. Conclusion: The newly-defined low-risk group has a low risk of progression to HGD/EAC. The findings support the clinical definition and highlight the potential to reduce surveillance in this large group of BE patients.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Stougie, Pim and Vilsteren, Frederike van |
| Faculty: | Medical Sciences |
| Date Deposited: | 23 Feb 2026 14:55 |
| Last Modified: | 23 Feb 2026 14:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3896 |
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