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

Mathew Vithayathil; Ines Modolell; Jacobo Ortiz-Fernandez-Sordo; Apostolos Pappas; Wladyslaw Januszewicz; Maria O’Donovan; Michele Bianchi; Jonathan R. White; Philip Kaye; Krish Ragunath; Massimiliano di Pietro

doi:10.1055/a-2015-8883

Endoscopy, Table of Contents

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

¹Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom

²Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom

,

Ines Modolell

³Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom

,

Jacobo Ortiz-Fernandez-Sordo

⁴Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom

,

Apostolos Pappas

¹Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom

,

Wladyslaw Januszewicz

¹Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom

⁵Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland

,

Maria O’Donovan

⁶Department of Histopathology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom

,

Michele Bianchi

¹Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom

,

Jonathan R. White

⁴Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom

,

Philip Kaye

⁷Department of Histopathology, Nottingham University Hospital NHS Foundation Trust, Nottingham, United Kingdom

,

Krish Ragunath

⁴Nottingham Digestive Diseases Centre and NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom

,

Massimiliano di Pietro

¹Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, United Kingdom

³Department of Gastroenterology, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom

› Author Affiliations

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.

Full Text

References

References
1 Desai TK, Krishnan K, Samala N. et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett’s oesophagus: a meta-analysis. Gut 2012; 61: 970-976
2 Fitzgerald RC, 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
3 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
4 Shaheen NJ, Falk GW, Iyer PG. et al. Diagnosis and management of Barrett’s esophagus: an updated ACG Guideline. Am J Gastroenterol 2022; 117: 559-587
5 Cooper GS, Yuan Z, Chak A. et al. Association of prediagnosis endoscopy with stage and survival in adenocarcinoma of the esophagus and gastric cardia. Cancer 2002; 95: 32-38
6 El-Serag HB, Naik AD, Duan Z. et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut 2016; 65: 1252-1260
7 Verbeek RE, Leenders M, Ten Kate FJW. et al. Surveillance of Barrett’s esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study. Am J Gastroenterol 2014; 109: 1215-1222
8 Corley DA, Mehtani K, Quesenberry C. et al. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology 2013; 145: 312-319
9 Levine DS, Haggitt RC, Blount PL. et al. An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett’s esophagus. Gastroenterology 1993; 105: 40-50
10 Sharma P, Hawes RH, Bansal A. et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett’s oesophagus: a prospective, international, randomised controlled trial. Gut 2013; 62: 15-21
11 Longcroft-Wheaton G, Fogg C, Chedgy F. et al. A feasibility trial of acetic acid-targeted biopsies versus nontargeted quadrantic biopsies during Barrett’s surveillance: the ABBA trial. Endoscopy 2020; 52: 29-36
12 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
13 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
14 Roumans CAM, van der Bogt RD, Steyerberg EW. et al. Adherence to recommendations of Barrett’s esophagus surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2020; 52: 17-28
15 Vithayathil M, Modolell I, Ortiz-Fernandez-Sordo J. et al. Image-enhanced endoscopy and molecular biomarkers vs Seattle protocol to diagnose dysplasia in Barrett’s esophagus. Clin Gastroenterol Hepatol 2022; 20: 2514-2523
16 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
17 Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 2002; 51: 130-131
18 Cameron GR, Jayasekera CS, Williams R. et al. Detection and staging of esophageal cancers within Barrett’s esophagus is improved by assessment in specialized Barrett’s units. Gastrointest Endosc 2014; 80: 971-983
19 Schölvinck DW, van der Meulen K, Bergman JJGHM. et al. Detection of lesions in dysplastic Barrett’s esophagus by community and expert endoscopists. Endoscopy 2017; 49: 113-120
20 Nguyen TH, Thrift AP, George R. et al. Prevalence and predictors of missed dysplasia on index Barrett’s esophagus diagnosing endoscopy in a veteran population. Clin Gastroenterol Hepatol 2022; 20: e876-e889
21 Vajravelu RK, Kolb JM, Thanawala SU. et al. Characterization of prevalent, post-endoscopy, and incident esophageal cancer in the United States: a large retrospective cohort study. Clin Gastroenterol Hepatol 2022; 20: 1739-1747
22 Desai M, Lieberman D, Srinivasan S. et al. Post-endoscopy Barrett’s neoplasia after a negative index endoscopy: a systematic review and proposal for definitions and performance measures in endoscopy. Endoscopy 2022; 54: 881-889
23 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
24 Beg S, Ragunath K, Wyman A. et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66: 1886-1899
25 Sharma P, Meining AR, Coron E. et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011; 74: 465-472

Supplementary Material

Supplementary material