Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett's esophagus - 15/08/12
Reprint requests: Prateek Sharma, MD, Gastroenterology (111), Department of Veterans Affairs Medical Center, 4801 East Linwood Boulevard, Kansas City, MO 64128-2295Résumé |
Background |
Current guidelines recommend that endoscopic surveillance of Barrett's esophagus (BE) be performed by using a strict biopsy protocol. However, novel methods to improve BE surveillance are still needed.
Objective |
To evaluate the impact of Barrett's inspection time (BIT) on yield of surveillance.
Design |
Post hoc analysis of data obtained from a clinical trial.
Setting |
Five tertiary referral centers.
Patients |
Patients undergoing BE surveillance.
Interventions |
Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch.
Main Outcome Measurements |
Endoscopically suspicious lesions, high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC).
Results |
A total of 112 patients underwent endoscopic surveillance by 11 individual endoscopists. Patients with longer BITs were more likely to have an endoscopically suspicious lesion (P < .001) and more endoscopically suspicious lesions (P = .0001) and receive a diagnosis of HGD/EAC (P = .001). There was a direct correlation between the endoscopist's mean BIT per centimeter of BE and the detection of patients with HGD/EAC (ρ = .63, P = .03). Endoscopists who had an average BIT longer than 1 minute per centimeter of BE detected more patients with endoscopically suspicious lesions (54.2% vs 13.3%, P = .04), and there was a trend toward a higher detection rate of HGD/EAC (40.2% vs 6.7%, P = .06).
Limitations |
Post hoc analysis of an enriched study population and experienced endoscopists at tertiary referral centers.
Conclusions |
Longer time spent inspecting the BE segment is associated with the increased detection of HGD/EAC. Taking additional time to perform a thorough examination of the BE mucosa may serve as an easy and widely available method to improve the yield of BE surveillance.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, BIT, EAC, HD-WLE, HGD, IM, LGD
Plan
| See CME section; p. 621. |
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| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: P. Sharma has received research grants from Olympus America. A. Rastogi has received research grants from Olympus America and has been supported by the Michael V. Sivak, Jr., MD, Endoscopic Research Award and Endoscopic Research Career Development Award from the ASGE. The other authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Sharma at psharma@kumc.edu. |
Vol 76 - N° 3
P. 531-538 - septembre 2012 Retour au numéro
Article précédent
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