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CC BY 4.0 · Endoscopy 2022; 54(10): 936-944
DOI: 10.1055/a-1754-7309
Original article

Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitals

Esther A. Nieuwenhuis‡   * 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Sanne N. van Munster‡   * 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Wouter L. Curvers
 2   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
,
Bas L. A. M. Weusten
 3   Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands
 4   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Lorenza Alvarez Herrero
 3   Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands
,
Auke Bogte
 4   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Alaa Alkhalaf
 5   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
B. Ed Schenk
 5   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Arjun D. Koch
 6   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Manon C. W. Spaander 
 6   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Thjon J. Tang
 7   Department of Gastroenterology and Hepatology, IJsselland Hospital, Cappelle aan den Ijssel, The Netherlands
,
Wouter B. Nagengast
 8   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Jessie Westerhof
 8   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Martin H. M. G. Houben
 9   Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands
,
Jacques J.G.H.M. Bergman
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Erik J. Schoon   **
 2   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
10   GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
,
Roos E. Pouw   **
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
11   Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, The Netherlands
,
on behalf of the Dutch Barrett Expert Centers › Author Affiliations
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Referred to by:

Centralized care for the management of Barrett’s esophagus: the path forward or just an academic dream?Endoscopy 2022; 54(10): 945-947
DOI: 10.1055/a-1843-9682

Corrected by:

Correction: Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitalsEndoscopy 2022; 54(10): C15-C15
DOI: 10.1055/a-1914-2490

Abstract

Background The optimal management for patients with low grade dysplasia (LGD) in Barrett’s esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. “confirmed LGD”), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD.

Methods This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC.

Results Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE.

Conclusion One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.

*  Co-first authors.


** Co-senior authors.




Publication History

Received: 31 October 2021

Accepted: 28 January 2022

Accepted Manuscript online:
28 January 2022

Article published online:
31 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
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