Model predicted Barrett’s esophagus progression

Barrett’s esophagus (BE) is the only known precursor lesion to esophageal adenocarcinoma (EAC), a rapidly rising cancer in the Western world, which has a poor 5-year survival rate of less than 20%. Management strategies to affect EAC incidence include screening and surveillance, with current guidelines recommending surveillance for all patients with a diagnosis of BE.
However, there are several challenges associated with adopting BE surveillance for all patients: It is estimated that anywhere from 2 million to 5 million U.S. adults may harbor BE, and the overall risk of BE progression to EAC is low (approximately 0.2%-0.4% annually). Both of these factors influence the cost-effectiveness of a global BE surveillance program.
Hence, a risk-stratification score that can distinguish BE patients who are at high risk for progression to high-grade dysplasia (HGD) and/or EAC from those whose disease will not progress will be extremely useful. This concept would be similar to other risk-scoring mechanisms, such as the MELD score for progression in liver disease.

With use of a large multicenter cohort of patients with BE (more than 4,500 patients), this is the first risk-prediction score developed and validated using baseline demographic and endoscopy information to determine risk of progression. Readily available factors such as patient sex, smoking status, BE length, and confirmed histology were identified as risk factors for progression, which could then generate a score determining the individual patient’s risk of progression. Such a simple scoring system has the potential of tailoring management based on the risk factors. In the future, inclusion of molecular biomarkers along with this score may further enhance its potential for personalized medicine in BE patients.
Prateek Sharma, MD, is a professor of medicine of University of Kansas, Kansas City. He has no conflicts of interest.