Patients With Barrett’s Esophagus and Indefinite Dysplasia: What To Do?

Patients With Barrett’s Esophagus and Indefinite Dysplasia: What To Do?

Prateek Sharma, MD, FASGE, reviewing Krishnamoorthi R, et al. Gastrointest Endosc 2020 Jan.

The risk of progression in Barrett’s esophagus (BE) with low-grade dysplasia has been well defined from previous studies with annual rates of progression to esophageal adenocarcinoma (EAC) at 0.5% and to high-grade dysplasia (HGD) and/or EAC at 1.7%. However, in several instances, biopsy specimens from patients with BE are interpreted by pathologists as indefinite for dysplasia (BE-IND). This is a clinically difficult entity to manage since there are no consensus guidelines on its management due to a lack of data on its risk of progression to HGD and/or EAC.

In this recently published meta-analysis of 8 studies that met inclusion criteria, the pooled incidence of HGD and/or EAC in BE-IND (n=1441) was 1.5 per 100 person-years (95% confidence interval [CI], 1.0-2.0; I2=56.5). Five of the 8 studies (n=1266) reported incidence of EAC to be 0.6 per 100 person-years (95% CI, 0.1-1.1; I2=89.0). Subgroup analysis showed that the incidence rate of EAC was higher in European studies (compared to North American studies). All the studies in the review were of medium or high quality.


So, how do we manage patients with BE-IND? The first step should be optimization of acid suppression therapy to ensure that the presence of esophagitis and/or inflammation does not impact histopathological evaluation. The endoscopy should be repeated to rule out the presence of a visible lesion in the BE segment by a careful inspection of the mucosa, followed by adequate biopsy sampling. If IND persists on the second endoscopy, second opinion should be obtained on histopathology slides. A follow-up surveillance endoscopy in 12 months is reasonable if BE-IND persists.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Prateek Sharma, MD, FASGE


Krishnamoorthi R, Mohan BP, Jayaraj M, et al. Risk of progression in Barrett’s esophagus indefinite for dysplasia: a systematic review and meta-analysis. Gastrointest Endosc 2020;91:3-10.e3. (

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