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CC BY 4.0 · Endoscopy 2023; 55(06): 491-498
DOI: 10.1055/a-2015-8883
Original article

The effect of procedural time on dysplasia detection rate during endoscopic surveillance of Barrett’s esophagus

Mathew Vithayathil
1   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
2   Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
,
Ines Modolell
3   Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
,
Jacobo Ortiz-Fernandez-Sordo
4   Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
,
Apostolos Pappas
1   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
,
Wladyslaw Januszewicz
1   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
5   Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
,
Maria O’Donovan
6   Department of Histopathology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
,
Michele Bianchi
1   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
,
Jonathan R. White
4   Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
,
Philip Kaye
7   Department of Histopathology, Nottingham University Hospital NHS Foundation Trust, Nottingham, United Kingdom
,
Krish Ragunath
4   Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom
,
Massimiliano di Pietro
1   Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
3   Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
› Author AffiliationsSupported by: Cambridge Cancer Research Funds Charity
Supported by: Experimental Cancer Medicine Centre A0427637
Supported by: Cancer Research UK Pump Priming Research Grant A25117
Supported by: NIHR Cambridge Biomedical Research Centre BRC-1215–20014
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Referred to by:

Author commentary on Mathew Vithayathil et al.Endoscopy 2023; 55(06): v15-v15
DOI: 10.1055/a-2001-3918

Referred to by:

High quality Barrett’s endoscopy: inspection time is a critical componentEndoscopy 2023; 55(06): 499-500
DOI: 10.1055/a-2042-9837

Abstract

Background Endoscopic surveillance of Barrett’s esophagus (BE) with Seattle protocol biopsies is time-consuming and inadequately performed in routine practice. There is no recommended procedural time for BE surveillance. We investigated the duration of surveillance procedures with adequate tissue sampling and effect on dysplasia detection rate (DDR).

Methods We performed post hoc analysis from the standard arm of a crossover randomized controlled trial recruiting patients with BE (≥C2 and/or ≥M3) and no clearly visible dysplastic lesions. After inspection with white-light imaging, targeted biopsies of subtle lesions and Seattle protocol biopsies were performed. Procedure duration and biopsy number were stratified by BE length. The effect of endoscopy-related variables on DDR was assessed by multivariable logistic regression.

Results Of 142 patients recruited, 15 (10.6 %) had high grade dysplasia/intramucosal cancer and 15 (10.6 %) had low grade dysplasia. The median procedural time was 16.5 minutes (interquartile range 14.0–19.0). Endoscopy duration increased by 0.9 minutes for each additional 1 cm of BE length. Seattle protocol biopsies had higher sensitivity for dysplasia than targeted biopsies (86.7 % vs. 60.0 %; P = 0.045). Longer procedural time was associated with increased likelihood of dysplasia detection on quadrantic biopsies (odds ratio [OR] 1.10, 95 %CI 1.00–1.20, P = 0.04), and for patients with BE > 6 cm also on targeted biopsies (OR 1.21, 95 %CI 1.04–1.40; P = 0.01).

Conclusions In BE patients with no clearly visible dysplastic lesions, longer procedural time was associated with increased likelihood of dysplasia detection. Adequate time slots are required to perform good-quality surveillance and maximize dysplasia detection.

Tables 1 s–4 s, Fig. 1 s



Publication History

Received: 22 May 2022

Accepted after revision: 23 November 2022

Accepted Manuscript online:
19 January 2023

Article published online:
09 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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