Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis
Background/Aims The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-lin...
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Korean Society of Gastrointestinal Endoscopy
2025-05-01
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| Series: | Clinical Endoscopy |
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| Online Access: | http://e-ce.org/upload/pdf/ce-2024-211.pdf |
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| author | Vishali Moond Pradeep Yarra Mannat Bhatia Sheza Malik Vineel Malavarappu Hassam Ali Saurabh Chandan Douglas G. Adler Babu P. Mohan |
| author_facet | Vishali Moond Pradeep Yarra Mannat Bhatia Sheza Malik Vineel Malavarappu Hassam Ali Saurabh Chandan Douglas G. Adler Babu P. Mohan |
| author_sort | Vishali Moond |
| collection | DOAJ |
| description | Background/Aims The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line. Methods We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Results Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia. Conclusions Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines. |
| format | Article |
| id | doaj-art-7c1f8a039aa6466f8db8bff48a5eddef |
| institution | DOAJ |
| issn | 2234-2400 2234-2443 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Korean Society of Gastrointestinal Endoscopy |
| record_format | Article |
| series | Clinical Endoscopy |
| spelling | doaj-art-7c1f8a039aa6466f8db8bff48a5eddef2025-08-20T03:16:21ZengKorean Society of Gastrointestinal EndoscopyClinical Endoscopy2234-24002234-24432025-05-0158337738510.5946/ce.2024.2117972Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysisVishali Moond0Pradeep Yarra1Mannat Bhatia2Sheza Malik3Vineel Malavarappu4Hassam Ali5Saurabh Chandan6Douglas G. Adler7Babu P. Mohan8 Department of Internal Medicine, Saint Peter’s University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ, USA Department of Gastroenterology & Hepatology, Saint Louis University, St. Louis, MO, USA Department of Internal Medicine, Saint Peter’s University Hospital/Robert Wood Johnson Medical School, New Brunswick, NJ, USA Department of Internal Medicine, Reading Hospital, West Reading, PA, USA Carver College of Medicine, University of Iowa, Iowa City, IA, USA Department of Gastroenterology, Hepatology & Nutrition, ECU Health Medical Center/Brody School of Medicine, Greenville, NC, USA Division of Gastroenterology & Hepatology, Creighton University School of Medicine, Omaha, NE, USA Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, CO, USA Department of Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, FL, USABackground/Aims The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line. Methods We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Results Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia. Conclusions Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.http://e-ce.org/upload/pdf/ce-2024-211.pdfbarrett esophagusesophagusguideline adherencemetaplasianeoplasms |
| spellingShingle | Vishali Moond Pradeep Yarra Mannat Bhatia Sheza Malik Vineel Malavarappu Hassam Ali Saurabh Chandan Douglas G. Adler Babu P. Mohan Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis Clinical Endoscopy barrett esophagus esophagus guideline adherence metaplasia neoplasms |
| title | Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis |
| title_full | Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis |
| title_fullStr | Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis |
| title_full_unstemmed | Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis |
| title_short | Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis |
| title_sort | prevalence of intestinal metaplasia dysplasia and esophageal adenocarcinoma in patients with irregular z line a systematic review and meta analysis |
| topic | barrett esophagus esophagus guideline adherence metaplasia neoplasms |
| url | http://e-ce.org/upload/pdf/ce-2024-211.pdf |
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