DIAGNOSTIC ADEQUACY OF BARRETT'S ESOPHAGUS IN A TERTIARY REFERENCE CENTER. PRELIMINARY ANALYSIS

Aims:

Some patients are wrongly typified with Barrett's esophagus (BE) in spite they don't meet criteria: presence of intestinal metaplasia (IM) and columnar segment longer than 1 cm. We didn't find studies focused on this fact so we decided to assess it and estimate the number of unnecessary follow-ups and factors contributing to a wrong categorization.

Methods:

Retrospective-descriptive study, tertiary reference endoscopy unit in Spain. Search in ENDOBASE server for any endoscopy including “Barrett” in its indication, description or diagnosis in endoscopies between December 2013 and May 2018. We excluded follow-up endoscopies due to reasons different from BE.

Results:

1178 endoscopies in 712 patients were included. 63,2% of cohort (745/1178) didn't meet BE criteria, 30,2% did and in 6,5% it wasn't possible to know due to lack of reporting.

58,9% of specimens showed no IM, 32,8% showed IM and in 8,2% it wasn't possible to know. 29,9% of patients had a columnar segment shorter than 1 cm.

Within the 745 endoscopies not meeting BE criteria, 37,7% (281/745) corresponded to 1^st or later follow-up endoscopies and 18.9% (141/745) to 2^nd or later follow-up endoscopies. Thus, at least 50.2% (141/281) of follow-up endoscopies were likely unnecessary during the study period.

In 90.5% of endoscopies (1066/1178) the word “Barrett” was utilized (BE, suspicious for Barrett, rule out BE, ultrashort Barrett, etc.) in diagnostic section.

A gastroenterologist requested 67,1% of procedures.

C or M length weren't reported in 8,9% and 12,2% of endoscopies.

Conclusions:

In our area, BE is over-diagnosed mostly due to absence of IM. Half of endoscopies for BE surveillance during the study period could be unnecessary.

Improvements in BE follow-up indication, pathology and endoscopic reporting are warranted.

Further descriptive and multicenter studies focused on BE diagnostic adequacy-reporting are needed.