Indefinite for Dysplasia in Barrett’s Esophagus Carries Substantial Risk for Neoplasia

Study Overview

In this retrospective cohort study spanning over two decades, Dr. Brian White and colleagues investigated the long-term outcomes of patients with Barrett’s Esophagus (BE) diagnosed as “indefinite for dysplasia” (IND). Drawing from institutional databases at the University of Pennsylvania, the team found that IND carries a substantial risk for both early (prevalent) and delayed (incident) neoplasia—including high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC).

Their analysis revealed that nearly 10% of patients had neoplasia within the first year of IND diagnosis, and an additional 22% developed incident neoplasia with longer follow-up. Risk factors included BE segment length and smoking history. These findings provide important data to guide surveillance strategies and risk stratification for this clinically ambiguous diagnosis.

Key Findings

• 9.9% of patients with IND had neoplasia detected within 1 year—most within 6 months.
• 22% of patients without prevalent neoplasia developed incident neoplasia over a median 4.4 years of follow-up.
• The incident rate of high-grade dysplasia or cancer was 1.73 per 100 person-years—comparable to that seen in patients with low-grade dysplasia.
• Longer BE segment length and smoking were consistently associated with higher neoplasia risk.

Clinical Significance

These findings underscore the importance of early and careful follow-up for patients with IND. The elevated risk for both early and late neoplasia suggests that surveillance strategies for IND should be more closely aligned with those for patients with confirmed low-grade dysplasia. Additionally, the study emphasizes the value of pathology consensus review, long-term follow-up, and real-world data in guiding surveillance guidelines.