Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate

Abstract

Background and study aim Barrett’s esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR).

Patients and methods This was a prospective study of patients undergoing BE surveillance at two hospitals – community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett’s surveillance over the preceding 5-year period.

Results A total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (P  < 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A.

Conclusion This study demonstrated that a group of trained endoscopists undertaking Barrett’s surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett’s surveillance lists.

• References

• 1 Rubenstein JH, Scheiman JM, Sadeghi S. et al. Esophageal adenocarcinoma incidence in individuals with gastroesophageal reflux: synthesis and estimates from population studies. Am J Gastroenterol 2011; 106: 254-260
• 2 Cancer Research UK. Oesophageal cancer statistics. Available from
• 3 Fitzgerald R, 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
• 4 Inadomi JM, Sampliner R, Lagergren J. et al. Screening and surveillance of Barrett esophagus in high-risk groups: a cost-utility analysis. Ann Intern Med 2003; 138: 176-186
• 5 Curvers WL, Alvarez-Herrero L, Wallace MB. et al. Endoscopic tri-modal imaging is more effective than standard endoscopy in identifying early-stage neoplasia in Barrett’s esophagus. Gastroenterology 2010; 139: 1106-1114
• 6 Wolfsen HC, Crook JE, Krishna M. et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology 2008; 135: 24-31
• 7 Canto MI, Anandasabapathy S, Brugge W. et al. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014; 79: 211-221
• 8 Levine DS, Blount PL, Rudolph RE. et al. Safety of a systematic endoscopic biopsy protocol in patients with Barrett’s esophagus. Am J Gastroenterol 2000; 95: 1152-1157
• 9 Abrams JA, Kapel RC, Lindberg GM. et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol 2009; 7: 736-742
• 10 Das D, Ishaq S, Harrison R. et al. Management of Barrett’s esophagus in the UK: Overtreated and underbiopsied but improved by the introduction of a national randomized trial. Am J Gastroenterol 2008; 103: 1079-1089
• 11 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
• 12 Abela JE, Going JJ, Mackenzie JF. et al. Systematic four-quadrant biopsy detects Barrett’s dysplasia in more patients than nonsystematic biopsy. Am J Gastroenterol 2008; 103: 850-855
• 13 Sharma P, Falk GW, Weston AP. et al. Dysplasia and cancer in a large multicenter cohort of patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2006; 4: 566-572
• 14 Hvid-Jensen F, Pedersen L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 375-383
• 15 Schouten LJ, Steevens J, Huysentruty CJ. et al. Total cancer incidence and overall mortality are not increased among patients with Barrett’s esophagus. Clin Gastroenterol Hepatol 2011; 9: 754-761
• 16 Gupta N, Gaddam S, Wani SB. et al. Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc 2012; 76: 531-538
• 17 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
• 18 Phoa KN, van Vilsteren FG, Weusten BL. et al. Radiofrequency ablation vs. endoscopic surveillance for patients with Barrett’s esophagus and low-grade dysplasia: a randomized clinical trial. JAMA 2014; 31: 1209-1217
• 19 Curvers WL, ten Kate FJ, Krishnadath KK. et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010; 105: 1523-1530
• 20 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. Endoscopy 2016; 48: 843-864