Endoscopy 2019; 51(04): S107
DOI: 10.1055/s-0039-1681485
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Esophagus diagnosis and ablation South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

CLINICAL CONSEQUENCES OF NON-ADHERENCE IN SURVEILLANCE OF BARRETT'S ESOPHAGUS: A MULTICENTER PROSPECTIVE COHORT STUDY

CAM Roumans
1   Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
2   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
RD van der Bogt
1   Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
D Nieboer
2   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
EW Steyerberg
2   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
3   Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
,
D Rizopoulos
4   Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
I Lansdorp-Vogelaar
2   Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
K Biermann
5   Department of Pathology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
MJ Bruno
1   Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
,
MCW Spaander
1   Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Guideline recommendations for surveillance of Barrett's esophagus (BE) aim to reduce heterogeneity and to improve quality of care. We aimed to estimate the clinical consequences of non-adherence on (1) the endoscopic resectability of esophageal adenocarcinoma (EAC), (2) mortality due to EAC, and (3) the risk of misdiagnosis of grade of dysplasia.

Methods:

In this multicenter prospective cohort study, data from BE patients were collected in 13 hospitals. We assessed the proportion of (non-)adherent endoscopies for both surveillance interval and Seattle protocol (1) in patients with EAC at stage ≤T1a or >T1a, and (2) in patients with mortality due to EAC. Also, (3) the probability of misdiagnosis of grade of dysplasia due to non-adherence to the Seattle protocol was estimated with a multistate Markov model.

Results:

3815 endoscopies were performed in 726 BE patients; in 18 patients EAC was detected. Adherence to the recommended surveillance interval or the Seattle protocol did not influence endoscopic resectability of EAC (p = 0.68 & p = 0.34, respectively). Six patients died due to EAC. Two deceased during surveillance. The surveillance interval was among these patients, if non-adherent, shorter than recommended; the Seattle protocol was followed appropriately particularly in their last endoscopies. In the remaining four patients neoplastic progression was detected at surveillance endoscopies and they deceased after drop-out due to therapy complications or EAC recurrence. The risk of misdiagnosis of grade of dysplasia was reduced by 23% if biopsied according to the Seattle protocol (OR 0.77, 95% CI 0.60 – 0.98).

Conclusions:

The disadvantageous effect of non-adherence to guideline recommendations may be limited with respect to endoscopic resectability of EAC and mortality. These results are in line with the lack of evidence underpinning the guideline. Despite the proven effectiveness of the Seattle protocol, it is time-consuming and error-prone due to non-adherence. Other strategies should be evaluated to estimate the neoplastic progression risk.