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. 2018 Dec;63(12):3262-3271.
doi: 10.1007/s10620-018-5257-3. Epub 2018 Sep 3.

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett's Esophagus

Jorge D Machicado  1 , Samuel Han  1 , Rena H Yadlapati  1 , Violette C Simon  1 , Bashar J Qumseya  2 , Shahnaz Sultan  3 , Vladimir M Kushnir  4 , Sri Komanduri  5 , Amit Rastogi  6 , V Raman Muthusamy  7 , Rehan Haidry  8 , Krish Ragunath  9 , Rajvinder Singh  10 , Hazem T Hammad  1 , Nicholas J Shaheen  11 , Sachin Wani  12
Affiliations

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett's Esophagus

Jorge D Machicado et al. Dig Dis Sci. 2018 Dec.

Abstract

Background: Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett's esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.

Methods: An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS3D). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables.

Results: The survey response rate was 84% (61/73)-41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS3D. Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10-29%) and highest for VLE (30%, IQR 20-50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001).

Conclusion: These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

Keywords: Advanced imaging modalities; Barrett’s esophagus; Practice patterns; Surveillance.

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Conflict of interest statement

Conflict of interest The other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Attitudes on the minimum incremental diagnostic yield (IDY) of individual advanced endoscopic imaging technologies for detection of dysplasia/cancer to be considered of clinical benefit and be implemented in clinical practice. NBI: narrow band imaging or related technology; CC: conventional chromoendoscopy; CLE: confocal laser endomicroscopy; VLE: volumetric laser endomicroscopy; WATS3D: wide-area transepithelial sample with 3D analysis
See this image and copyright information in PMC

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