Adherence to guideline recommendations for Barrett's esophagus (BE) surveillance endoscopies: Effects of dedicated BE endoscopy lists

Abstract

Background and study aims For non-dysplastic Barrett’s Esophagus (BE) patients, guidelines recommend endoscopic surveillance every 3 to 5 years with four-quadrant random biopsies every 2 cm of BE length. Adherence to these guidelines is low in clinical practice. Pooling BE surveillance endoscopies on dedicated endoscopy lists performed by dedicated endoscopists could possibly enhance guideline adherence, detection of visible lesions, and dysplasia detection rates (DDRs).

Patients and methods Data were used from the ACID-study (Netherlands Trial Registry NL8214), a prospective trial of BE surveillance in the Netherlands. BE patients with known or previously treated dysplasia were excluded. Guideline adherence, detection of visible lesions, and DDRs were compared for patients on dedicated and general endoscopy lists.

Results A total of 1,244 patients were included, 318 on dedicated lists and 926 on general lists. Endoscopies on dedicated lists showed significantly higher adherence to the random biopsy protocol (85% vs. 66%, P <0.01) and recommended surveillance intervals (60% vs. 47%, P <0.01) compared to general lists. Detection of visible lesions (8.8% vs. 8.1%, P=0.79) and DDRs were not significantly different (6.9% and 6.6%, P=0.94). None (0.0%) of the patients scheduled on dedicated lists and 10 (1.1%) on general lists were diagnosed with esophageal adenocarcinoma (P=0.07). In multivariable analysis, dedicated lists were significantly associated with biopsy protocol adherence and adherence to surveillance interval recommendations with odds ratios of 4.45 (95% confidence interval [CI] 2.07–9.57) and 1.64 (95% CI 1.03–2.61), respectively.

Conclusions Dedicated endoscopy lists are associated with better adherence to the random biopsy protocol and surveillance interval recommendations.

Keywords

Endoscopy Upper GI Tract - Reflux disease - Barrett's and adenocarcinoma - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE)

• References

• 1 Bollschweiler E, Wolfgarten E, Gutschow C. et al. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001; 92: 549-555
• 2 Derakhshan MH, Arnold M, Brewster DH. et al. Worldwide inverse association between gastric cancer and esophageal adenocarcinoma suggesting a common environmental factor exerting opposing effects. Am J Gastroenterol 2016; 111: 228-239
• 3 Then EO, Lopez M, Saleem S. et al. Esophageal cancer: an updated surveillance epidemiology and end results database analysis. World J Oncol 2020; 11: 55-64
• 4 Phoa KN, Pouw RE, Bisschops R. et al. Multimodality endoscopic eradication for neoplastic Barrett oesophagus: results of a European multicentre study (EURO-II). Gut 2016; 65: 555-562
• 5 Van Munster S, Nieuwenhuis E, Weusten BLAM. et al. Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: Results from the national Dutch database in a 10-year period. Gut 2022; 71: 265-276
• 6 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
• 7 Qumseya B, Sultan S, Bain P. et al. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc 2019; 90: 335-359
• 8 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
• 9 Spechler S, Sharma P, Rhonda F. et al. American gastroenterological association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140: 1084-1091
• 10 Weusten BLAM, 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
• 11 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
• 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; 850-855
• 13 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
• 14 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
• 15 Harris PA, Taylor R, Thielke R. et al. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381
• 16 Harris PA, Taylor R, Minor BL. et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
• 17 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
• 18 Britton J, Chatten K, Riley T. et al. Dedicated service improves the accuracy of Barrett’s oesophagus surveillance: A prospective comparative cohort study. Frontline Gastroenterol 2019; 10: 128-134
• 19 Desai M, Lieberman DA, Kennedy KF. et al. Increasing prevalence of high-grade dysplasia and adenocarcinoma on index endoscopy in Barrett’s esophagus over the past 2 decades: data from a multicenter U.S. consortium. . Gastrointest Endosc 2019; 89: 257-263.e3
• 20 Parasa S, Desai M, Vittal A. et al. Estimating neoplasia detection rate (NDR) in patients with Barrett’s oesophagus based on index endoscopy: A systematic review and meta-analysis. Gut 2019; 68: 2122-2128
• 21 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