High Risk of Persistence and Risk of Dysplasia after Ultrashort Barrett’s Diagnosis

The management of ultrashort (< 1cm) Barrett's esophagus (BE) remains unclear. We aimed to determine the prevalence of ultrashort BE (USBE) at index diagnosis, identify factors associated with persistent BE after USBE diagnosis, and identify risk of dysplasia after initial USBE in a population of United States veterans. This was a retrospective cohort study at the Veterans Affairs hospital in Houston, TX of consecutive patients with new BE diagnosis from 11/1990 to 6/2022 with follow-up through 4/2023. Using a pathology database, we identified patients with a new USBE diagnosis and any subsequent follow up EGD. We examined the association of sociodemographic and clinical risk factors of persistent USBE cohort compared to longer length segment BE and those with a negative follow up EGD after index USBE with chi-square tests and logistic regression models. Lastly, we calculated the prevalence and incidence of any dysplasia in persistent BE after USBE at index diagnosis compared to BE≥1cm. We excluded patients without at least 1 follow up endoscopy. Of 739 patients with BE, 167 (22.6%) had USBE on index EGD. Of those with index USBE, 86 (51.5%) had persistent BE and 67 (40.1%) had negative IM on follow up EGD. There was a greater proportion of non-Hispanic white and Hispanic than non-Hispanic black patients with persistent BE after index USBE and the negative follow up EGD cohorts (p=0.012), but no significant difference in age, sex, smoking status, alcohol status, and body mass index (BMI) between the two groups. White race (adjusted aOR 3.80; 95% CI 1.35-10.7) and Hispanic ethnicity (aOR 4.85; 95% CI 1.19-19.7; ref: non-Hispanic black) were associated with an increased likelihood of persistent BE. During 3,880.7 person-years of follow-up, 112 patients (10 persistent BE after index USBE) developed definite dysplasia/neoplasia. The incidence rate of definite dysplasia/neoplasia was 19.5 per 1,000 person-years (95% CI, 10.5-36.3 per 1,000 person-years) in those with persistent BE after USBE and 33.8 per 1,000 person-years (95% CI, 27.9-41.1 per 1,000 person-years) in those with longer segment BE (p-value by log-rank test=0.23; hazard ratio 0.67; 95% CI, 0.35-1.29). We did not identify any significant predictors of dysplasia in persistent BE after index endoscopy with USBE. The prevalence of persistent BE after index USBE is high, and there is a risk of developing dysplasia/neoplasia in persistent BE after USBE. We were unable to detect a difference in the risk of dysplasia/neoplasia between persistent BE after index USBE and BE ≥1cm on index endoscopy in a cohort of United States veterans. White race and Hispanic ethnicity are associated with persistent BE after index USBE and may be target demographics for surveillance.