S869 Temporal Trends of High Grade Dysplasia in the Esophagus and GE Junction

Introduction: Current guidelines that focus on the prevention and early detection of esophageal adenocarcinomas may not impact gastroesophageal junction (GEJ) adenocarcinomas, although both are rising in incidence in the United States. To determine the import and to help develop potential future strategies we retrospectively reviewed patients with high-grade dysplasia (HGD) of the esophagus and HGD of the GEJ using a prospectively collected database. Methods: Data on gastroesophageal reflux disease (GERD) symptoms, risk factors, endoscopic findings, and pathology have been collected prospectively since 1995 from all patients with non-dysplastic Barrett’s esophagus (BE), dysplastic GEJ or dysplastic BE, and cancers of the esophagus or GEJ who consent. The database was searched to identify all patients with HGD. Three blinded endoscopists reviewed available de-identified images of the lower third of the esophagus and GEJ from 16 subjects with confirmed HGD and Prague maximum scores ≤1. Junctional HGD was defined as no visible columnar metaplasia in the distal esophagus, or involvement limited to a <5 mm island. Cases where at least 2 endoscopists agreed were classified as junctional or short segment HGD. Chi-squares, Fisher’s exact, or Student t tests were calculated with R v4.5.0 to compare known BE risk factors between groups. The temporal incidence of junctional dysplasia and short-segment BE (SSBE) in the prospectively collected database was explored. Results: Ten cases of junctional HGD, 31 cases of SSBE with HGD, and 90 cases of long-segment BE with HGD were identified. There was no significant difference in BE risk factors (male sex, White race, mean age, obesity, smoking history, GERD, or family history) found between groups. Temporally, HGD cases within SSBE and junctional HGD were only seen within the past 10 years (P-value = 0.0008) and past 5 years (P-value < 0.0001), respectively. Conclusion: Patients with junctional HGD who are at risk of progression to junctional cancer have the same risk factors as BE patients with HGD. Although current guidelines do not recommend endoscopic screening and surveillance for intestinal metaplasia of the GEJ because the progression risk is low, junctional HGD appears to be increasing. Strategies to routinely identify junctional HGD may need to be developed to effectively prevent junctional adenocarcinomas.