Edward H Tsoi1, Puneet Mahindra2, Georgina Cameron2, Richard Williams3, Richard Norris4, Paul V Desmond1, Spiro Raftopoulos5, Darren Pavey6, Arti Rattan6, Luke F Hourigan7, Richard Lee8, Michael J Bourke9, Naaz Sidhu10, Rajvinder Singh11, Andrew Chan11, Sudarshan Krishnamurthi11, Andrew C F Taylor1. 1. Department of Gastroenterology, St Vincent's Hospital Melbourne, Victoria, Australia; The Faculty of Medicine, University of Melbourne, Victoria, Australia. 2. Department of Gastroenterology, St Vincent's Hospital Melbourne, Victoria, Australia. 3. The Faculty of Medicine, University of Melbourne, Victoria, Australia; Department of Pathology, St Vincent's Hospital Melbourne, Victoria, Australia. 4. Department of Pathology, St Vincent's Hospital Melbourne, Victoria, Australia. 5. Department of Gastroenterology, Sir Charles Gairdner Hospital, Western Australia, Australia. 6. Department of Gastroenterology, Bankstown Lidcombe Hospital, New South Wales, Australia. 7. Department of Gastroenterology, Princess Alexandra Hospital, Queensland, Australia; Gallipoli Medical Research Institute, School of Medicine, The University of Queensland, Greenslopes Private Hospital, Brisbane, Queensland, Australia. 8. Department of Gastroenterology, Princess Alexandra Hospital, Queensland, Australia. 9. Department of Gastroenterology, Westmead Hospital, New South Wales, Australia; Western Clinical School, University of Sydney, New South Wales, Australia. 10. Department of Gastroenterology, Westmead Hospital, New South Wales, Australia. 11. Department of Gastroenterology, Lyell McEwin Hospital, South Australia, Australia.
Abstract
BACKGROUND AND AIMS: The reported progression rate from low-grade dysplasia (LGD) in Barrett's esophagus (BE) to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) ranges from .4% to 13.4% per year. We hypothesize that some reported progression rates may be overestimated because of prevalent HGD or EAC that was not identified during endoscopic assessments performed in the community. Our aim is to determine the proportion of prevalent HGD or EAC detected by BE referral units (BERUs) in patients referred from the community with a recent diagnosis of LGD. METHODS: All patients referred from the community to 6 BERUs with a diagnosis of BE with LGD were identified. Patients with an assessment endoscopy performed at BERUs more than 6 months from their referral endoscopy in the community were excluded. Visible lesions and histology outcomes were compared between the community referral endoscopy and the assessment endoscopy performed at BERUs. RESULTS: The median time between BERU assessment and referral endoscopy was 79 days (interquartile range, 54-114). Of the 75 patients referred from the community with LGD, BERU assessment identified HGD or EAC in 20 patients (27%). BERU assessment identified more visible lesions than referral endoscopy performed in the community (39 [52%] vs 9 [12%], respectively; P = .029). CONCLUSIONS: BERU assessment endoscopy identified more visible lesions than community referral endoscopy and identified HGD or EAC in 27% of patients referred from the community with a recent diagnosis of LGD. Reported progression rates from LGD to HGD or EAC may be overestimated. Crown
BACKGROUND AND AIMS: The reported progression rate from low-grade dysplasia (LGD) in Barrett's esophagus (BE) to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) ranges from .4% to 13.4% per year. We hypothesize that some reported progression rates may be overestimated because of prevalent HGD or EAC that was not identified during endoscopic assessments performed in the community. Our aim is to determine the proportion of prevalent HGD or EAC detected by BE referral units (BERUs) in patients referred from the community with a recent diagnosis of LGD. METHODS: All patients referred from the community to 6 BERUs with a diagnosis of BE with LGD were identified. Patients with an assessment endoscopy performed at BERUs more than 6 months from their referral endoscopy in the community were excluded. Visible lesions and histology outcomes were compared between the community referral endoscopy and the assessment endoscopy performed at BERUs. RESULTS: The median time between BERU assessment and referral endoscopy was 79 days (interquartile range, 54-114). Of the 75 patients referred from the community with LGD, BERU assessment identified HGD or EAC in 20 patients (27%). BERU assessment identified more visible lesions than referral endoscopy performed in the community (39 [52%] vs 9 [12%], respectively; P = .029). CONCLUSIONS: BERU assessment endoscopy identified more visible lesions than community referral endoscopy and identified HGD or EAC in 27% of patients referred from the community with a recent diagnosis of LGD. Reported progression rates from LGD to HGD or EAC may be overestimated. Crown
Authors: Jin Lin Tan; Mohamed Asif Chinnaratha; Richard Woodman; Rory Martin; Hsiang-Ting Chen; Gustavo Carneiro; Rajvinder Singh Journal: Front Med (Lausanne) Date: 2022-06-22
Authors: Esther A Nieuwenhuis; Sanne N van Munster; Wouter L Curvers; Bas L A M Weusten; Lorenza Alvarez Herrero; Auke Bogte; Alaa Alkhalaf; B Ed Schenk; Arjun D Koch; Manon C W Spaander; Thjon J Tang; Wouter B Nagengast; Jessie Westerhof; Martin H M G Houben; Jacques J G H M Bergman; Erik J Schoon; Roos E Pouw Journal: Endoscopy Date: 2022-01-28 Impact factor: 9.776