How is Early Barrett’s Cancer Currently Diagnosed and Treated in Western Europe? Results of a Survey at 52 University Hospitals in Eight Western European Countries

Abstract

Background and study aims: Endoscopic treatment is increasingly being accepted for early Barrett’s cancer (EBC), as it is associated with few complications, excellent long-term results, and almost no mortality. This study investigated current standards and treatment strategies for EBC in eight countries in Western Europe.

Methods: A standardized questionnaire with questions on the endoscopic diagnosis, staging, and treatment of EBC was developed and sent to 107 university gastroenterology departments. The data were analyzed anonymously.

Results: The response rate was 49 % (52/107). For work-up of early Barrett’s neoplasia, 67 % of hospitals use high-resolution endoscopes, with routine four-quadrant and targeted biopsies of visible lesions in 94 % of the cases. Narrow-band imaging and chromoendoscopy are used in 67 % of the cases, and other advanced imaging and staining techniques in 65 %. Before treatment, 63 % of the respondents recommended conventional endosonography, 6 % miniprobe endosonography, and 19 % both. Endoscopic resection is carried out at 98 % of the hospitals. Argon plasma coagulation is used for ablation in 52 % of the cases and radiofrequency ablation in 27 %. An 80-year-old patient with localized mucosal EBC would be treated endoscopically in all of the hospitals. Endoscopic therapy was recommended for 50-year-old patients with mucosal EBC by 87 % of the hospitals; esophageal resection was recommended for multifocal EBC by 15 % in 80-year-old patients, by 63 % in 50-year-old patients and by 44 % in patients with incipient submucosal infiltration.

Conclusions: About two-thirds of the university hospitals use high-resolution endoscopy and advanced imaging. Endoscopic therapy is the accepted standard for treating localized mucosal Barrett’s cancer in Western Europe; esophageal resection is recommended by the majority (63 %) for a young patient with multifocal EBC.

Zusammenfassung

Einleitung: Die endoskopische Therapie wird aufgrund ihrer sehr guten Langzeitergebnisse sowie einer sehr geringen Morbidität und Mortalität zunehmend als Therapie der Wahl des Barrett-Frühkarzinoms (BFK) angesehen. Ziel dieser Arbeit war es, die aktuelle Praxis in Westeuropa in Diagnostik und Therapie von BFKs zu untersuchen.

Methodik: Es wurde ein standardisierter Fragebogen zur detaillierten Diagnostik und Therapie des BFK erstellt. Der Fragebogen wurde an die leitenden Ärzte gastroenterologischer Abteilungen von insgesamt 107 Universitätskliniken versandt. Die die Auswertung der zurückgesandten Fragebögen erfolgte anonymisiert.

Ergebnisse: Der Anteil der zurückgesandten Fragebögen betrug 49 % (52/107). In der Diagnostik werden von 67 % High-Resolution-Endoskope sowie von 94 % der Kliniken sowohl 4-Quadranten-PEs als auch gezielte Biopsien eingesetzt. Die Chromoendoskopie findet zu 67 % (virtuell: NBI/FICE) bzw. 65 % (konventionell) Einsatz. Vor Therapie wird von 63 % der Kliniken eine konventionelle Endosonografie durchgeführt, Minisonden finden nur in 6 % der Kliniken allein einen Einsatz. In 19 % werden beide Verfahren kombiniert. Eine endoskopische Resektion führen 98 % der Unikliniken durch. Argonplasmakoagulation wird von 52 % verwendet, Radiofrequenzablation von 27 %. Ein unifokales mukosales BFK bei einem 80-jährigen Patienten würden 100 % der Unikliniken rein endoskopisch therapieren, bei einem 50-jährigen Patienten sind es noch 87 %. Bei multifokalem Auftreten eines mukosalen BFK gaben 15 % (80-jähriger Patient) bzw. 63 % (50-jähriger Patient) die radikale Ösophagusreseketion als ihre Therapie der Wahl an.

Schlussfolgerung: Etwa zwei Drittel der universitären Zentren verwenden High-Resolution-Endoskope sowie Advanced Imaging. Die endoskopische Therapie stellt mittlerweile in Westeuropa die Standardtherapie des lokalisierten BFK dar. Bei multifokalem Auftreten jedoch wird von der Mehrheit der universitären Zentren (63 %) weiterhin die Ösophagusresektion empfohlen.

Key words

esophagus - Barrett’s esophagus - esophageal cancer

Schlüsselwörter

Ösophagus - Barrett-Ösophagus - Ösophaguskarzinom

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