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

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; on behalf of the Dutch Barrett Expert Centers

doi:10.1055/a-1754-7309

Endoscopy, Table of Contents

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‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands

,

Sanne N. van Munster‡^*

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands

,

Wouter L. Curvers

²Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands

,

Bas L. A. M. Weusten

³Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands

⁴Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

,

Lorenza Alvarez Herrero

³Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands

,

Auke Bogte

⁴Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

,

Alaa Alkhalaf

⁵Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands

,

B. Ed Schenk

⁵Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands

,

Arjun D. Koch

⁶Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands

,

Manon C. W. Spaander

⁶Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands

,

Thjon J. Tang

⁷Department of Gastroenterology and Hepatology, IJsselland Hospital, Cappelle aan den Ijssel, The Netherlands

,

Wouter B. Nagengast

⁸Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

,

Jessie Westerhof

⁸Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

,

Martin H. M. G. Houben

⁹Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands

,

Jacques J.G.H.M. Bergman

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands

,

Erik J. Schoon^**

²Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands

¹⁰GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands

,

Roos E. Pouw^**

¹Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands

¹¹Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, The Netherlands

,

on behalf of the Dutch Barrett Expert Centers

› Author Affiliations

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.

Full Text

References

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