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
1   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
2   Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
,
David Lieberman
3   Department of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA
,
Sachin Srinivasan
2   Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
,
Venkat Nutalapati
2   Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
,
Abhishek Challa
2   Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
,
Pankush Kalgotra
4   Raymond J. Harbert College of Business, Auburn University, Auburn, Alabama, USA
,
1   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
5   Department of Medicine, St. Peterʼs University Hospital, New Brunswick, New Jersey, USA
,
Alessandro Repici
6   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
7   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Cesare Hassan
6   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
7   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Michal F. Kaminski
8   Department 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
9   Institute of Health and Society, University of Oslo, Oslo, Norway
,
Prateek Sharma
1   Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
2   Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
› Author Affiliations


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.

Appendix 1 s, Tables 1 s–4 s, Figs. 1 s–3 s



Publication History

Received: 27 July 2021

Accepted after revision: 03 January 2022

Accepted Manuscript online:
03 January 2022

Article published online:
25 March 2022

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