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. 2023 Oct 11;11(10):E952-E962.
doi: 10.1055/a-2125-0161. eCollection 2023 Oct.

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

I N Beaufort  1   2 , A N Milne  3 , Y A Alderlieste  4 , J E Baars  5 , P R Bos  6 , J P W Burger  7 , N C M van Heel  8 , M Ledeboer  9 , R J Lieverse  10 , P C van de Meeberg  11 , J J Meeuse  12 , A H J Naber  13 , H J M Pullens  14 , R C H Scheffer  15 , M Sikkema  16 , R E Verbeek  17 , M A M T Verhagen  18 , W van de Vrie  19 , M Willems  20 , B L A M Weusten  1   2
Affiliations

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

I N Beaufort et al. Endosc Int Open. .

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

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Patient inclusion.
Fig. 2
Fig. 2
Adherence to random 4Q biopsy protocol stratified by maximum BE length. Adherence was defined as four quadrant random biopsies every 2 cm of circumferential BE extent, plus at least one biopsy every 2 cm of BE tongues. In the presence of visible lesions, target biopsies and random biopsies were totalled.
Fig. 3
Fig. 3
Boxplots showing the time since previous endoscopy in years for general endoscopy lists and for dedicated BE endoscopy lists, stratified by BE length. Within each box, the median time since previous endoscopy is indicated by the horizontal black line. The box encompasses the 25 th and 75 th percentiles of each group, whereas the vertical lines represent the values within 1.5 of the interquartile range of the 25 th and the 75 th percentiles. The dots denote outliers that fall above the upper fence or below the lower fence.
Fig. 4
Fig. 4
Adherence to surveillance interval recommendations for general and dedicated BE endoscopy lists. Surveillance intervals were considered adequate if surveillance endoscopies were performed within 4.5 to 5.5 years for BE segments <3 cm, within 2.5 to 3.5 years for BE segments ≥3 cm to 10 cm, and within 1.5 to 3.5 years for BE segments ≥10 cm.
See this image and copyright information in PMC

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