Post-endoscopy Barrett’s neoplasia after a negative index endoscopy: a systematic review and proposal for definitions and performance measures in endoscopy

Madhav Desai; David Lieberman; Sachin Srinivasan; Venkat Nutalapati; Abhishek Challa; Pankush Kalgotra; Suneha Sundaram; Alessandro Repici; Cesare Hassan; Michal F. Kaminski; Prateek Sharma

doi:10.1055/a-1729-8066

Endoscopy, Inhaltsverzeichnis

Endoscopy 2022; 54(09): 881-889
DOI: 10.1055/a-1729-8066

Systematic review

Post-endoscopy Barrett’s neoplasia after a negative index endoscopy: a systematic review and proposal for definitions and performance measures in endoscopy

Madhav Desai

¹Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA

²Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

David Lieberman

³Department of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA

,

Sachin Srinivasan

²Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Venkat Nutalapati

²Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Abhishek Challa

²Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

,

Pankush Kalgotra

⁴Raymond J. Harbert College of Business, Auburn University, Auburn, Alabama, USA

,

Suneha Sundaram

¹Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA

⁵Department of Medicine, St. Peterʼs University Hospital, New Brunswick, New Jersey, USA

,

Alessandro Repici

⁶Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

⁷IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Cesare Hassan

⁶Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

⁷IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Michal F. Kaminski

⁸Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, and Department of Gastroenterology, Hepatology and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland

⁹Institute of Health and Society, University of Oslo, Oslo, Norway

,

Prateek Sharma

¹Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA

²Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA

› Institutsangaben

Abstract

Background A high rate of neoplasia, both high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) has been reported in Barrett’s esophagus at index endoscopy, but precise rates of post-endoscopy Barrett’s neoplasia (PEBN) are unknown.

Methods A systematic review and meta-analysis was performed examining electronic databases (inception to October 2021) for studies reporting PEBN. Consistent with the definitions of post-colonoscopy colorectal cancer proposed by the World Endoscopy Organization, we defined neoplasia (HGD/EAC) detected at index endoscopy and/or within 6 months of a negative index endoscopy as “prevalent” neoplasia, that detected after 6 months of a negative index endoscopy and prior to next surveillance interval (i. e. 3 years) as PEBN or “interval” neoplasia, and that detected after 36 months from a negative index endoscopy as “incident” neoplasia. The pooled incidence rates and proportions relative to total neoplasia were analyzed.

Results 11 studies (n = 59 795; 61 % men; mean [SD] age 62.3 [3.3] years) met the inclusion criteria. The pooled incidence rates were: prevalent neoplasia 4.5 % (95 %CI 2.2 %–8.9 %) at baseline and an additional 0.3 % (0.1 %–0.7 %) within the first 6 months, PEBN 0.52 % (0.46 %–0.58 %), and incident neoplasia 1.4 % (0.9 %–2.1 %). At 3 years from the index endoscopy, PEBN accounted for 3 % of total Barrett’s neoplasia, while prevalent neoplasia accounted for 97 %.

Conclusion Neoplasia detected at or within 6 months of index endoscopy accounts for most cases of Barrett’s neoplasia (> 90 %). PEBN accounts for ~3 % of cases and can be used for validation in future. This highlights the importance of a high quality index endoscopy in Barrett’s esophagus and the need to establish quality benchmarks to measure endoscopists’ performance.

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