{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:48:54Z","timestamp":1773236934964,"version":"3.50.1"},"reference-count":24,"publisher":"BMJ","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1991,12]]},"abstract":"<jats:p>Columnar lined oesophagus (Barrett's oesophagus) carries a risk for the development of adenocarcinoma. Epithelial dysplasia appears to be a precursor but the utility of this marker for predicting subsequent adenocarcinoma is unsettled. We therefore prospectively studied 81 patients with histologically proven columnar epithelium of at least the distal 3 cm of the tubular oesophagus with regular endoscopic biopsies for a total of 289.2 patient years (mean 3.6 years, range 0.5-8). Twenty three patients (28%) had epithelial dysplasia detected during follow up. Both patients with persistent high grade dysplasia present on initial biopsies developed adenocarcinoma after 2.6-4.5 years, despite the absence of gross macroscopic change. The initial single layer pleomorphic high grade dysplasia in one patient regressed to low grade dysplasia which has persisted for 1.5 years. Of 10 patients with initial low grade dysplasia, one progressed to adenocarcinoma in 4.3 years. The low grade dysplasia persisted unchanged in seven patients for 1.5-7 years and appears to have regressed in two patients after three to five years. Ten patients developed low grade dysplasia during the surveillance period. This has persisted unchanged in six patients from 0.5-5 years, regressed in three for 0.5-5 years and has appeared after the first yearly biopsy in one patient. No patient without dysplasia has developed adenocarcinoma. The incidence of adenocarcinoma in Barrett's oesophagus in this study is one case per 96 patient years. This is 61 times (95% confidence limits 12-176) the age adjusted incidence of oesophageal cancer in Australia. Persistent high grade dysplasia appears to be a sensitive indicator for the development of subsequent adenocarcinoma.<\/jats:p>","DOI":"10.1136\/gut.32.12.1441","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1441-1446","source":"Crossref","is-referenced-by-count":203,"title":["Only patients with dysplasia progress to adenocarcinoma in Barrett's oesophagus."],"prefix":"10.1136","volume":"32","author":[{"given":"M","family":"Miros","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Kerlin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Walker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1991,12,1]]},"reference":[{"key":"ref_1","article-title":"Barrett's esophagus. Comparison of benign and malignant cases. Ann cinoma although this may be up to 4 5 years Surg 1983; 198: 554-66. later. Others have followed patients with high grade dysplasia for up to six years with no progression to adenocarcinoma.62326 Hameeteman et al22 prospectively followed seven patients","author":"Skinner, D.B.; Walther, B.C.; Riddell, R.H.","unstructured":"Skinner DB, Walther BC, Riddell RH, et al. Barrett's esophagus. Comparison of benign and malignant cases. Ann cinoma although this may be up to 4 5 years Surg 1983; 198: 554-66. later. Others have followed patients with high grade dysplasia for up to six years with no progression to adenocarcinoma.62326 Hameeteman et al22 prospectively followed seven patients with"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ajcp\/70.1.1","article-title":"Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus","volume":"70","author":"Haggitt, R.C.; Tryzelaar, J.; Ellis, F.H.; Colcher, H.","year":"1978","unstructured":"Haggitt RC, Tryzelaar J, Ellis FH, Colcher H. Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus. AmJ Clin Pathol 1978; 70: 1-5.","journal-title":"AmJ Clin Pathol"},{"key":"ref_3","first-page":"817","article-title":"Regression of Barrett's epithelium after anti-reflux surgery","volume":"79","author":"Sprung, D.J.; Ellis, F.H.; Gibb, S.P.","year":"1984","unstructured":"Sprung DJ, Ellis FH, Gibb SP. Regression of Barrett's epithelium after anti-reflux surgery. [Abstract]. Am J high grade dysplasia. Five progressed rapidly to adenocarcinoma. No progression to adenocarcinoma occurred in the other two patients over 36 and 44 months. Gastroenterol 1984; 79: 817.","journal-title":"Am; high grade dysplasia. Five progressed rapidly to adenocarcinoma. No progression to adenocarcinoma occurred in the other two patients over 36 and 44 months"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1056\/NEJM198510033131404","article-title":"The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus","volume":"313","author":"Cameron, A.J.; Ott, B.J.; Payne, W.S.","year":"1985","unstructured":"Cameron AJ, Ott BJ, Payne WS. The incidence of adenocarcinoma in columnar-lined (Barrett's) esophagus. N Engl J Med 1985; 313: 857-9.","journal-title":"N Engl J Med"},{"key":"ref_5","first-page":"301","article-title":"The relationship between Little information is available about the development and progression of low grade dysplasia. Our results indicate that 20% of patients with Barrett's oesophagus will have documented columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus","volume":"87","author":"Hamilton, SR, Smith; R.R.L.","year":"1987","unstructured":"Hamilton SR, Smith RRL. The relationship between Little information is available about the development and progression of low grade dysplasia. Our results indicate that 20% of patients with Barrett's oesophagus will have documented columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett's esophagus. AmJ Clin Pathol 1987; 87: 301-12.","journal-title":"AmJ Clin Pathol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1146\/annurev.me.38.020187.002401","article-title":"Barrett's esophagus and adenocarcinoma","volume":"38","author":"Reid, B.J.; Weinstein, W.M.","year":"1987","unstructured":"Reid BJ, Weinstein WM. Barrett's esophagus and adenocarcinoma. Ann Rev Med 1987; 38: 477-92.","journal-title":"Ann Rev Med"},{"key":"ref_7","article-title":"The histologic spectrum of Barrett's oesophagus. N EnglJ7 had low grade dysplasia on his initial biopsy, the Med 1976; 295: 476-80. total period of low grade dysplasia before progression to adenocarcinoma is uncertain","author":"Paull, A.; Trier, J.S.; Dalton, M.D.; Camp, R.C.; Loeb, P.; Goyal, R.K.","unstructured":"Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett's oesophagus. N EnglJ7 had low grade dysplasia on his initial biopsy, the Med 1976; 295: 476-80. total period of low grade dysplasia before progression to adenocarcinoma is uncertain. A"},{"key":"ref_8","first-page":"931","article-title":"Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications","volume":"14","author":"Riddeli, R.H.; Goldman, H.; Ransohoff, D.F.","year":"1983","unstructured":"Riddeli RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hwn Pathol 1983; 14: 931-","journal-title":"Hwn Pathol"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/S0046-8177(88)80344-7","article-title":"Observer variation in the diagnosis of dysplasia in Barrett's esophagus","volume":"19","author":"Reid, B.J.; Haggitt, R.C.; Rubin, C.E.","year":"1988","unstructured":"Reid BJ, Haggitt RC, Rubin CE, et al. Observer variation in the diagnosis of dysplasia in Barrett's esophagus. Hum Pathol 1988; 19: 166-78.","journal-title":"Hum Pathol"},{"key":"ref_10","first-page":"143","article-title":"Dysplasia and regression in Barrett's epithelium","volume-title":"Barrett's esophagus: the study by Hameeteman et al.22 Other modalities currently being investigated to determine more accurately which patients with pathophysiology, diagnosis and management","author":"Riddell, R.H.","year":"1985","unstructured":"Riddell RH. Dysplasia and regression in Barrett's epithelium. In: Spechler SJ, Goyal RK, eds. Barrett's esophagus: the study by Hameeteman et al.22 Other modalities currently being investigated to determine more accurately which patients with pathophysiology, diagnosis and management. New York: Elsevier Science Publishing, 1985: 143-52."},{"key":"ref_11","article-title":"Dysplasia in Barrett's esophagus","volume-title":"Cancer Res Clin It is our current policy to offer endoscopic Oncol 1985; 110: 145-52. surveillance to all patients with Barrett's oesophagus who are suitable and willing to have an oesophagectomy if adenocarcinoma is found. As patients without dysplasia do not progress to","author":"Schmidt, H.G.; Riddel, R.H.; Walther, B.; Skinner, D.B.; Riemann, J.F.","year":"J","unstructured":"Schmidt HG, Riddel RH, Walther B, Skinner DB, Riemann JF. Dysplasia in Barrett's esophagus. J Cancer Res Clin It is our current policy to offer endoscopic Oncol 1985; 110: 145-52. surveillance to all patients with Barrett's oesophagus who are suitable and willing to have an oesophagectomy if adenocarcinoma is found. As patients without dysplasia do not progress to"},{"key":"ref_12","article-title":"Hospital morbidity 1988. Brisbane: Australian Government Printer, Catalogue No 4303.3","author":"Australian Bureau of Statistics","unstructured":"Australian Bureau of Statistics. Hospital morbidity 1988. Brisbane: Australian Government Printer, Catalogue No 4303.3."},{"key":"ref_13","article-title":"Statistical methods in cancer research. Lyon: International Agency for Research in Cancer: 1980 malignancy in the medium term, we recommend second yearly endoscopic biopsies for these patients. Patients with high grade dysplasia should have the dysplasia confirmed and adenocarcinoma excluded with immediate repeat endoscopic biopsies. Ifhigh grade dysplasia only is still present and the patient is young and fit, an oesophagectomy should be performed, as all patients eventually develop invasive adenocarcinoma. Older patients or patients with an 71","author":"Brerlow, N.E.; Day, N.E.","unstructured":"Brerlow NE, Day NE. Statistical methods in cancer research. Lyon: International Agency for Research in Cancer: 1980 malignancy in the medium term, we recommend second yearly endoscopic biopsies for these patients. Patients with high grade dysplasia should have the dysplasia confirmed and adenocarcinoma excluded with immediate repeat endoscopic biopsies. Ifhigh grade dysplasia only is still present and the patient is young and fit, an oesophagectomy should be performed, as all patients eventually develop invasive adenocarcinoma. Older patients or patients with an 71."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1136\/gut.30.1.14","article-title":"Adenocarcinoma in Barrett's oesophagus: an overrated risk","volume":"30","author":"der Veen AH, Van; J, Dee; JD, Blankensteiin; van Blankenstein M","year":"1989","unstructured":"Van der Veen AH, Dee J, Blankensteiin JD, van Blankenstein M. Adenocarcinoma in Barrett's oesophagus: an overrated risk. Gut 1989; 30: 14-8.","journal-title":"Gut"},{"key":"ref_15","first-page":"291","article-title":"The cost of surveillance for adenocarcinoma complicating Barrett's oesophagus","volume":"83","author":"Achkar, E.; Carey, W.","year":"1988","unstructured":"Achkar E, Carey W. The cost of surveillance for adenocarcinoma complicating Barrett's oesophagus. Am J Gastroenterol 1988; 83: 291-4.","journal-title":"Am J Gastroenterol"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/0016-5085(84)90090-8","article-title":"Adenocarcinoma and Barrett's esophagus. An overrated risk?","volume":"87","author":"Spechler, S.J.; Robbins, A.H.; Rubbins, H.B.","year":"1984","unstructured":"Spechler SJ, Robbins AH, Rubbins HB, et al. Adenocarcinoma and Barrett's esophagus. An overrated risk? Gastronerology 1984; 87:927-33.","journal-title":"Gastronerology"},{"key":"ref_17","first-page":"760","article-title":"Value of endoscopic surveillance in the detection of neoplastic change in Barrett's oesophagus. increased operative risk should be carefully followed up every six months for the development of invasive cancer. If only low grade dysplasia","volume":"75","author":"Robertson, C.S.; Mayberry, J.F.; Nicholson, D.A.; James, P.D.; Atkinson, M.","year":"1988","unstructured":"Robertson CS, Mayberry JF, Nicholson DA, James PD, Atkinson M. Value of endoscopic surveillance in the detection of neoplastic change in Barrett's oesophagus. increased operative risk should be carefully followed up every six months for the development of invasive cancer. If only low grade dysplasia is confirmed on two separate occasions, BrJtSurg 1988; 75:760-3."},{"key":"ref_18","first-page":"1249","article-title":"Barrett's esophagus: development of","volume-title":"dysplasia and adenocarcinoma. Gastroenterology 1989; 96","author":"Hameeteman, W.; Tytgat, G.N.J.; Houthoff, H.J.; van den Tweel, J.G.","unstructured":"Hameeteman W, Tytgat GNJ, Houthoff HJ, van den Tweel JG. Barrett's esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 1989; 96: 1249-56."},{"key":"ref_19","first-page":"1022","article-title":"Progress report on ACG Barrett's esophagus study","volume":"83","author":"McCallum, R.W.; Jacobson, L.; Fisher, K.","year":"1988","unstructured":"McCallum RW, Jacobson L, Fisher K. Progress report on ACG Barrett's esophagus study. [Abstract]. Am j Gastroenterol 1988; 83: 1022.","journal-title":"Am j Gastroenterol"},{"key":"ref_20","first-page":"1296","article-title":"A histologic evaluation of Barrett's esophagus using a standardized endoscopic biopsy protocol","volume":"86","author":"Weinstein, W.; Van Deventer, G.; Ippoliti, A.","year":"1984","unstructured":"Weinstein W, Van Deventer G, Ippoliti A. A histologic evaluation of Barrett's esophagus using a standardized endoscopic biopsy protocol. [Abstract]. Gastroenterology 1984; 86: 1296.","journal-title":"Gastroenterology"},{"key":"ref_21","first-page":"845","article-title":"Dysplasia in Barrett's esophagus. A clinicopathologic study of six patients. AmJ7 Surg","volume":"9","author":"Lee, R.G.","year":"1985","unstructured":"Lee RG. Dysplasia in Barrett's esophagus. A clinicopathologic study of six patients. AmJ7 Surg Pathol 1985; 9: 845-52.","journal-title":"Pathol"},{"key":"ref_22","first-page":"355","article-title":"Correlation of ultrastructural aberrations with dysplasia and flow cytometric abnormalities","volume-title":"Barrett's epithelium. Gastroenterology 1989; %","author":"Levine, D.S.; Reid, B.J.; Haggitt, R.C.; Rubin, C.E.; Rabinovitch, P.S.","unstructured":"Levine DS, Reid BJ, Haggitt RC, Rubin CE, Rabinovitch PS. Correlation of ultrastructural aberrations with dysplasia and flow cytometric abnormalities in Barrett's epithelium. Gastroenterology 1989; %: 355-67."},{"key":"ref_23","first-page":"1","article-title":"Barrett's esophagus. Correlation between flow cytometry and histology in detection of patients at risk for adenocarcinoma","volume":"93","author":"Reid, B.J.; Haggitt, R.C.; Rubin, C.E.; Rabinovitch, P.S.","year":"1987","unstructured":"Reid BJ, Haggitt RC, Rubin CE, Rabinovitch PS. Barrett's esophagus. Correlation between flow cytometry and histology in detection of patients at risk for adenocarcinoma. Gastroenterology 1987; 93: 1-11.","journal-title":"Gastroenterology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1136\/gut.30.7.899","article-title":"Value of DNA image cytometry in the prediction of malignant change in Barrett's oesophagus","volume":"30","author":"James, P.D.; Atkinson, M.","year":"1989","unstructured":"James PD, Atkinson M. Value of DNA image cytometry in the prediction of malignant change in Barrett's oesophagus. Gut 1989; 30: 899-905.","journal-title":"Gut"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.32.12.1441","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T13:44:28Z","timestamp":1765633468000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.32.12.1441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,12]]},"references-count":24,"journal-issue":{"issue":"12","published-online":{"date-parts":[[1991,12,1]]},"published-print":{"date-parts":[[1991,12]]}},"alternative-id":["10.1136\/gut.32.12.1441"],"URL":"https:\/\/doi.org\/10.1136\/gut.32.12.1441","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,12]]}}}