INTRODUCTION Data on time trends of dysplasia and esophageal adenocarcinoma (EAC) in Barrett's esophagus (BE) during the index endoscopy (ie, prevalent cases) are limited. Our aim was to determine the prevalence patterns of BE-associated dysplasia on index endoscopy over the past 25 years. METHODS The Barrett's Esophagus Study is a multicenter outcome project of a large cohort of patients with BE. Proportions of patients with index endoscopy findings of no dysplasia (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and EAC were extracted per year of index endoscopy, and 5-yearly patient cohorts were tabulated over years 1990 to 2010+ (2010-current). Prevalent dysplasia and endoscopic findings were trended over the past 25 years using percentage dysplasia (LGD, HGD, EAC, and HGD/EAC) to assess changes in detection of BE-associated dysplasia over the last 25 years. Statistical analysis was done using SAS version 9.4 software (SAS, Cary, NC). RESULTS A total of 3643 patients were included in the analysis with index endoscopy showing NDBE in 2513 (70.1%), LGD in 412 (11.5%), HGD in 193 (5.4%), and EAC in 181 (5.1%). Over time, there was an increase in the mean age of patients with BE (51.7 ± 29 years vs 62.6 ± 11.3 years) and the proportion of males (84% vs 92.6%) diagnosed with BE but a decrease in the mean BE length (4.4±4.3 cm vs 2.9±3.0 cm) as time progressed (1990-1994 to 2010-2016 time periods). The presence of LGD on index endoscopy remained stable over 1990 to 2016. However, a significant increase (148% in HGD and 112% in EAC) in the diagnosis of HGD, EAC, and HGD/EAC was noted on index endoscopy over the last 25 years (P < .001). There was also a significant increase in the detection of visible lesions on index endoscopy (1990-1994, 5.1%; to 2005-2009, 6.3%; and 2010+, 16.3%) during the same period. CONCLUSION Our results suggest that the prevalence of HGD and EAC has significantly increased over the past 25 years despite a decrease in BE length during the same period. This increase parallels an increase in the detection of visible lesions, suggesting that a careful examination at the index examination is crucial.

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在过去的20年中，Barrett食管的指数内窥镜检查显示，高度不典型增生和腺癌的患病率正在上升：来自美国一个多中心财团的数据。

引言在指数内窥镜检查（即常见病例）期间，Barrett食管（BE）中不典型增生和食管腺癌（EAC）的时间趋势数据有限。我们的目标是确定过去25年中在索引内窥镜检查中与BE相关的发育异常的患病率。方法Barrett食管研究是一项针对大量BE患者的多中心结局研究。每年从索引内窥镜检查中提取无内镜异型（NDBE），低度异型（LGD），高度异型（HGD）和EAC的内镜检查患者的比例，并逐年对5年患者队列进行制表1990年至2010年以上（2010年至今）。在过去的25年中，使用不典型增生的百分比（LGD，HGD，EAC，和HGD / EAC）以评估过去25年中与BE相关的发育异常的检测变化。使用SAS 9.4版软件（SAS，Cary，NC）进行统计分析。结果共有3643例患者接受了指数内镜检查，其中NDBE为2513（70.1％），LGD为412（11.5％），HGD为193（5.4％），EAC为181（5.1％）。随着时间的流逝，BE患者的平均年龄有所增加（51.7±29岁vs 62.6±11.3岁），诊断为BE的男性比例（84％vs 92.6％），但BE平均长度却有所减少（随着时间的推移（1990-1994年至2010-2016年期间）（4.4±4.3厘米对2.9±3.0厘米）。在1990年至2016年期间，索引内窥镜检查中LGD的存在保持稳定。但是，在诊断HGD，EAC，HGD / EAC在过去的25年中在索引内窥镜检查中被注意到（P <.001）。在同一时期内，通过索引内窥镜检查可见病变的数量也有显着增加（1990-1994年为5.1％； 2005-2009年为6.3％； 2010+年为16.3％）。结论我们的结果表明，尽管BE长度在同一时期有所减少，但HGD和EAC的患病率在过去25年中已显着增加。这种增加与可见病灶检测的增加平行，这表明在指标检查中进行仔细检查至关重要。结论我们的结果表明，尽管BE长度在同一时期有所减少，但HGD和EAC的患病率在过去25年中已显着增加。这种增加与可见病灶检测的增加平行，这表明在指标检查中进行仔细检查至关重要。结论我们的结果表明，尽管BE长度在同一时期有所减少，但HGD和EAC的患病率在过去25年中已显着增加。这种增加与可见病灶检测的增加平行，这表明在指标检查中进行仔细检查至关重要。