Experienced endoscopists improve Barrett’s surveillance outcomes independently of time allocation

We read the article by Ooi et al. with interest, noting the positive outcomes when using extended time slots and specially trained endoscopists for surveillance of Barrett’s esophagus (BE) [1]. We conducted an audit over a 6-month period in 2015, which also demonstrated significantly better performance when BE surveillance was carried out by experienced endoscopists (previously unpublished data).

In our audit, endoscopists were categorized as either surveillance specialists or nonspecialists, based on prior experience. Data were collected retrospectively from our endoscopy software, and comparison was made between the two groups with regard to adequate reporting using the Prague classification, adherence to the Seattle protocol for biopsies, and dysplasia detection rate (DDR).

Our cohort consisted of 96 patients (63 male, 33 female). A total of 25 procedures were carried out by surveillance specialists and 71 were performed by nonspecialist endoscopists. Specialist endoscopists were more likely to describe accurately the Barrett’s segment using the Prague classification (92 % vs. 29 %) as well as to take an adequate amount of biopsy material (80 % vs. 29 %) than their nonspecialist counterparts. DDR was also higher for the specialist endoscopists, as they were able to detect two new cases of low grade dysplasia (LGD) and one case of intramucosal cancer (IMC) compared with two new cases of LGD and two cases of high grade dysplasia (HGD) by the general endoscopists. Out of the HGD/IMC patients, all three had undergone prior surveillance 2 – 3 years beforehand, and a suboptimal amount of biopsy material had been taken in two of these. Furthermore, all three underwent repeat endoscopy prior to endoscopic treatment, and out of the two HGD cases that were picked up by the general endoscopists, both were found to have a prominent nodule or lesion that had been missed during the index endoscopy.

At our center, BE surveillance is performed at regular 15 minute time slots; however, it is now recognized that at least 1 minute of examination time should be dedicated to every 1 cm of BE [2]. We would like to ask the authors whether they feel that the better outcomes they obtained were indepedent of extended time allocation. It would also be interesting to know whether advanced imaging techniques, such as chromoendoscopy, were used by any of the endoscopists, and the impact of these techniques on total procedure time, as well as DDR.

Our audit mirrored some of the authors’ results and if dedicated BE surveillance lists cannot be organized, such procedures should at least be carried out by specially trained endoscopists, ideally in an extended time slot.

• References

• 1 Ooi J, Wilson P, Walker G. et al. Dedicated Barrett’s surveillance sessions managed by trained endoscopists improve dysplasia detection rate. Endoscopy 2017; 49: 524-528
• 2 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