Endoscopy 2017; 49(06): 524-528
DOI: 10.1055/s-0043-103410
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate

Joanne Ooi1, Patrick Wilson1, Giles Walker2, Paul Blaker1, Sabina DeMartino1, John O’Donohue2, David Reffitt2, Effie Lanaspre3, Fuju Chang4, John Meenan1, Jason M. Dunn1, 5
  • 1Department of Gastroenterology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
  • 2Department of Gastroenterology, Lewisham University Hospital, London, United Kingdom
  • 3Department of Histopathology, Lewisham University Hospital, London, United Kingdom
  • 4Department of Histopathology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
  • 5Institute of Medical Informatics, Oslo University Hospital, Norway
Further Information

Publication History

submitted 03 August 2016

accepted after revision 26 January 2017

Publication Date:
11 April 2017 (eFirst)

Abstract

Background and study aim Barrett’s esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR).

Patients and methods This was a prospective study of patients undergoing BE surveillance at two hospitals – community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett’s surveillance over the preceding 5-year period.

Results A total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (P  < 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A.

Conclusion This study demonstrated that a group of trained endoscopists undertaking Barrett’s surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett’s surveillance lists.