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Systematic Review and Meta-Analysis
- Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis
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Vishali Moond
, Pradeep Yarra, Mannat Bhatia, Sheza Malik, Vineel Malavarappu, Hassam Ali, Saurabh Chandan, Douglas G. Adler, Babu P. Mohan - Clin Endosc 2025;58(3):377-385. Published online March 31, 2025
- DOI: https://doi.org/10.5946/ce.2024.211
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Graphical Abstract
Abstract
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Supplementary Material - 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. -
Citations
Citations to this article as recorded by
- Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
Natalie J. Wilson, Nicholas Mordan, Cole Potrock, Nicholas J. Shaheen
American Journal of Gastroenterology.2026; 121(2): 302. CrossRef - Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef
- Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
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