Dysplasia of the stomach and Barrett esophagus: a follow-up study

Seventy-seven patients with biopsy-proven glandular dysplasia of the esophagus (39 patients) or stomach (38 patients) were followed for a mean of 44 mo or until resection. Of 34 patients with low-grade dysplasia at initial biopsy, 29 had no evidence of high-grade dysplasia or carcinoma on follow-up, three died of other causes, and two had severe dysplasia diagnosed on subsequent biopsy. Of 43 patients with high-grade dysplasia, 28 had no evidence of dysplasia on follow-up (four died of unrelated causes and two of postoperative complications). Fifteen were shown to have invasive carcinoma. Thirteen of the 15 diagnoses of invasive carcinoma were made within 12 mo of original endoscopy. Ulcerated high-grade dysplasias were more likely associated with carcinoma than were nonulcerated high-grade dysplasias (P = 0.001). The presence of ulceration and short time interval to the progression of carcinoma suggest that carcinoma may have been present at the time of initial biopsy in many cases. The frequency of adenocarcinoma's arising in severe dysplasia was slightly less in the stomach (29%) than in the esophagus (41%). We conclude that low-grade dysplasia is often indolent and that ulcerated high-grade dysplasia is often a marker for adjacent invasion.