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BACKGROUND AND AIMS: Risk of esophageal adenocarcinoma (EA) in those with Barrett’s esophagus (BE) is 11-fold greater than the general population. It remains unclear which BE patients are at highest risk of progression to EA. We aimed to validate a predictive model risk stratifying BE patients. METHODS: We conducted a retrospective cohort study at the Houston VA of consecutive patients with a new BE diagnosis from November 1990 to January 2019. Study follow-up was through 2/2020. Patients were excluded if they had no follow-up esophagogastroduodenoscopy (EGD) with esophageal biopsy after the initial BE-diagnosing EGD or evidence of high-grade dysplasia (HGD) or EA on initial EGD. We performed an external validation study of a risk model containing sex, smoking, BE length, and low-grade dysplasia (LGD) status and assessed discriminatory ability using area under the receiver operating characteristic curve (AUROC). RESULTS: Among 608 BE patients, 24 progressed to HGD/EA. The points-based model discriminated well with an AUROC of 0.72 (95% confidence interval [CI], 0.63–0.82). When categorized into low/intermediate/high-risk groups according to published cut-offs, the AUROC was poor at 0.57. Restructured into low-risk versus high-risk groups, the AUROC was 0.72 (95% CI, 0.64–0.80). Excluding baseline LGD did not reduce discriminatory ability (AUROC 0.73; 95% CI, 0.64–0.82). CONCLUSION: This external validation provides further evidence that the model including sex, LGD status, smoking status, and BE length may help to risk stratify BE patients. A simplified version excluding LGD status and/or reducing the number of risk groups has increased utility in clinical practice without loss of discriminatory ability. |
