BACKGROUND: Current guidelines recommend that endoscopic surveillance of Barrett's esophagus (BE) be performed by using a strict biopsy protocol. However, novel methods to improve BE surveillance are still needed. OBJECTIVE: To evaluate the impact of Barrett's inspection time (BIT) on yield of surveillance. DESIGN: Post hoc analysis of data obtained from a clinical trial. SETTING: Five tertiary referral centers. PATIENTS: Patients undergoing BE surveillance. INTERVENTIONS: Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch. MAIN OUTCOME MEASUREMENTS: Endoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC). RESULTS: A total of 112 patients underwent endoscopic surveillance by 11 individual endoscopists. Patients with longer BITs were more likely to have an endoscopically suspicious lesion (P < .001) and more endoscopically suspicious lesions (P = .0001) and receive a diagnosis of HGD/EAC (P = .001). There was a direct correlation between the endoscopist's mean BIT per centimeter of BE and the detection of patients with HGD/EAC (ρ = .63, P = .03). Endoscopists who had an average BIT longer than 1 minute per centimeter of BE detected more patients with endoscopically suspicious lesions (54.2% vs 13.3%, P = .04), and there was a trend toward a higher detection rate of HGD/EAC (40.2% vs 6.7%, P = .06). LIMITATIONS: Post hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers. CONCLUSIONS: Longer time spent inspecting the BE segment is associated with the increased detection of HGD/EAC. Taking additional time to perform a thorough examination of the BE mucosa may serve as an easy and widely available method to improve the yield of BE surveillance.
BACKGROUND: Current guidelines recommend that endoscopic surveillance of Barrett's esophagus (BE) be performed by using a strict biopsy protocol. However, novel methods to improve BE surveillance are still needed. OBJECTIVE: To evaluate the impact of Barrett's inspection time (BIT) on yield of surveillance. DESIGN: Post hoc analysis of data obtained from a clinical trial. SETTING: Five tertiary referral centers. PATIENTS: Patients undergoing BE surveillance. INTERVENTIONS: Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch. MAIN OUTCOME MEASUREMENTS: Endoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC). RESULTS: A total of 112 patients underwent endoscopic surveillance by 11 individual endoscopists. Patients with longer BITs were more likely to have an endoscopically suspicious lesion (P < .001) and more endoscopically suspicious lesions (P = .0001) and receive a diagnosis of HGD/EAC (P = .001). There was a direct correlation between the endoscopist's mean BIT per centimeter of BE and the detection of patients with HGD/EAC (ρ = .63, P = .03). Endoscopists who had an average BIT longer than 1 minute per centimeter of BE detected more patients with endoscopically suspicious lesions (54.2% vs 13.3%, P = .04), and there was a trend toward a higher detection rate of HGD/EAC (40.2% vs 6.7%, P = .06). LIMITATIONS: Post hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers. CONCLUSIONS: Longer time spent inspecting the BE segment is associated with the increased detection of HGD/EAC. Taking additional time to perform a thorough examination of the BE mucosa may serve as an easy and widely available method to improve the yield of BE surveillance.
Authors: Kavel Visrodia; Siddharth Singh; Rajesh Krishnamoorthi; David A Ahlquist; Kenneth K Wang; Prasad G Iyer; David A Katzka Journal: Gastroenterology Date: 2015-11-24 Impact factor: 22.682
Authors: Raf Bisschops; Miguel Areia; Emmanuel Coron; Daniela Dobru; Bernd Kaskas; Roman Kuvaev; Oliver Pech; Krish Ragunath; Bas Weusten; Pietro Familiari; Dirk Domagk; Roland Valori; Michal F Kaminski; Cristiano Spada; Michael Bretthauer; Cathy Bennett; Carlo Senore; Mário Dinis-Ribeiro; Matthew D Rutter Journal: United European Gastroenterol J Date: 2016-08-21 Impact factor: 4.623