RIBBON Network confirms progression risk in Barrett's

Ireland consortium estimates progression from Barrett's to esophageal adenocarcinoma or high grade dysplasia, finding risks similar to previous studies, but higher risk among confirmed low grade dysplasias.

Dis Esophagus. 2020 Mar 20;doaa009. doi: 10.1093/dote/doaa009. Online ahead of print.

Barrett's Registry Collaboration of Academic Centers in Ireland Reveals High Progression Rate of Low-Grade Dysplasia and Low Risk From Nondysplastic Barrett's Esophagus: Report of the RIBBON Network

Lisa M O'Byrne et al. PMID: 32193532 DOI: 10.1093/dote/doaa009


Barrett's esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett's epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19-4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context.

This website contains a curated and opinionated look at recent literature regarding the epidemiology and prevention of esophageal cancer, with an emphasis on esophageal adenocarcinoma. It is developed by Thomas L Vaughan MD, MPH, who can be reached with questions or suggestions through email or his research website.
©2021 Thomas L Vaughan
This website should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This site does not constitute the practice of any medical or other professional health care advice, diagnosis or treatment. The information on this website represent the views solely of Dr. Vaughan.
Cookies are used to quantify website use for resource planning.  Complete IP addresses are not collected (i.e., will be  recorded as 203.0.113.??) Feel free to opt out of cookies using add-ins of your choice without affecting website function.  No user information is collected by the risk calculator (IC-RISC).