Digestive Diseases and Sciences

, Volume 63, Issue 6, pp 1513–1517 | Cite as

Risk of Neoplastic Progression Among Patients with an Irregular Z Line on Long-Term Follow-Up

  • David Itskoviz
  • Zohar Levi
  • Doron Boltin
  • Alex Vilkin
  • Yifat Snir
  • Rachel Gingold-Belfer
  • Yaron Niv
  • Iris Dotan
  • Ram Dickman
Original Article



Barrett’s esophagus (BE) is a known complication of gastroesophageal reflux disease. In a previous study, we described a high prevalence of intestinal metaplasia (IM) in patients with an irregular Z line. However, the clinical importance of this finding is unclear.


To evaluate the long-term development of BE and relevant complications in patients diagnosed with an irregular Z line, with or without IM, on routine esophago-gastro-duodenoscopy (EGD).


In our previously described cohort, 166 out of 2000 consecutive patients were diagnosed with an incidental irregular Z line. Of those with irregular Z line, 43% had IM. In this continuation study, patients’ status was reassessed after a median follow-up of 70 months. Patients were divided into two groups: Patients with IM (IM-positive group) and without IM (IM-negative group). The incidence of long-term development of BE, dysplasia, and esophageal adenocarcinoma were compared between groups.


At least one follow-up EGD was performed in 102 (61%) patients with an irregular Z line. Endoscopic evidence of BE was found in eight IM-positive patients (8/50 [16%]) and in one IM-negative patient (1/52 [1.9%]). Two (4%) IM-positive patients developed BE with low-grade dysplasia. None of the patients developed high-grade dysplasia, or esophageal adenocarcinoma.


Patients with irregular Z line do not develop major BE complication in more than 5 years of follow-up.


Barrett’s esophagus Irregular Z line Esophageal carcinoma Dysplasia 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Maes S, Sharma P, Bisschops R. Review: surveillance of patients with Barrett oesophagus. Best Pract Res Clin Gastroenterol. 2016;30:901–912.CrossRefPubMedGoogle Scholar
  2. 2.
    Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG, clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.CrossRefPubMedGoogle Scholar
  3. 3.
    di Pietro M, Chan D, Fitzgerald RC, Wang KK. Screening for Barrett’s esophagus. Gastroenterology. 2015;148:912–923.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British society of gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Anaparthy R, Gaddam S, Kanakadandi V, et al. Association between length of Barrett’s esophagus and risk of high-grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol. 2013;11:1430–1436.CrossRefPubMedGoogle Scholar
  6. 6.
    Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut. 2012;61:970–976.CrossRefPubMedGoogle Scholar
  7. 7.
    Rastogi A, Puli S, El-Serag HB, Bansal A, Wani S, Sharma P. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high-grade dysplasia: a meta-analysis. Gastrointest Endosc. 2008;67:394–398.CrossRefPubMedGoogle Scholar
  8. 8.
    Singh S, Manickam P, Amin AV. Incidence of esophageal adenocarcinoma in Barrett’s esophagus with low-grade dysplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2014;79:897–909.e4.CrossRefPubMedGoogle Scholar
  9. 9.
    Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017;49:191–198.CrossRefPubMedGoogle Scholar
  10. 10.
    Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 2011;106:1447–1455.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    American Gastroenterological Association, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American gastroenterological association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091.CrossRefGoogle Scholar
  12. 12.
    Pohl H, Pech O, Arash H, et al. Length of Barrett’s oesophagus and cancer risk: implications from a large sample of patients with early oesophageal adenocarcinoma. Gut. 2016;65:196–201.CrossRefPubMedGoogle Scholar
  13. 13.
    Dickman R, Levi Z, Vilkin A, Zvidi I, Niv Y. Predictors of specialized intestinal metaplasia in patients with an incidental irregular Z line. Eur J Gastroenterol Hepatol. 2010;22:135–138.CrossRefPubMedGoogle Scholar
  14. 14.
    Thota PN, Vennalaganti P, Vennelaganti S, et al. Low risk of high-grade dysplasia or esophageal adenocarcinoma among patients with Barrett’s esophagus less than 1 cm (Irregular Z Line) within 5 years of index endoscopy. Gastroenterology. 2017;152:987–992.CrossRefPubMedGoogle Scholar
  15. 15.
    Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–1536.CrossRefPubMedGoogle Scholar
  16. 16.
    Pera M. Trends in incidence and prevalence of specialized intestinal metaplasia, Barrett’s esophagus, and adenocarcinoma of the gastroesophageal junction. World J Surg. 2003;27:999–1006.CrossRefPubMedGoogle Scholar
  17. 17.
    Byrne JP, Bhatnagar S, Hamid B, Armstrong GR, Attwood SEA. Comparative study of intestinal metaplasia and mucin staining at the cardia and esophagogastric junction in 225 symptomatic patients presenting for diagnostic open-access gastroscopy. Am J Gastroenterol. 1999;94:98–103.CrossRefPubMedGoogle Scholar
  18. 18.
    Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalovski M. Prospective evaluation of intestinal metaplasia and dysplasia within the cardia of patients with Barrett’s esophagus. Dig Dis Sci. 1997;42:597–602. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of GastroenterologyRabin Medical CenterPetah TikvaIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations