The adoption of ablation therapy for Barrett's esophagus: a cohort study of gastroenterologists.
OBJECTIVE
Although ablation therapy may be useful in the treatment of Barrett's esophagus. evidence of effectiveness is scarce, and little is known about current utilization of ablation. We aimed to determine whether the use of ablation was increasing in a cohort of gastroenterologists, and to identify physician beliefs and characteristics associated with ablation use.


METHODS
We surveyed a national sample of gastroenterologists about ablation use, with an 18-month follow-up. The self-administered instrument included questions about demographic characteristics, attitudes about ablation therapy, and prior experience with ablation. Case scenarios were also included. We used logistic regression to identify factors associated with the use of ablation in patients with Barrett's esophagus.


RESULTS
Two hundred seventy-nine (50.3% of those eligible) responded to the baseline survey. Few agreed that ablation lowers the risk of adenocarcinoma (15%) or is supported by the medical literature (19%). However, 25% of respondents reportedly had used ablation at baseline, and this increased to 36% in the follow-up survey (p = 0.0003). The use of ablation was significantly associated with physician age greater than 54 yr (odds ratio [OR] = 2.77, 95% CI = 1.04-7.37) and the belief that ablation was used by colleagues (OR = 13.27, 95% CI = 4.44-39.64) or decreases medical costs (OR = 5.07, 95% CI = 1.00-25.74).


CONCLUSIONS
Although few gastroenterologists agreed that ablation is effective, a significant proportion had adopted its use. There was a significant increase in ablation use during our study period, and the characteristic that was most strongly associated with ablation use was the belief that colleagues used it.
Gross
Cary P
CP
Primary Care Center, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Cruz-Correa
Marcia
M
Canto
Marcia Irene
MI
McNeil-Solis
Corlina
C
Valente
Thomas W
TW
Powe
Neil R
NR
D000328:Adult; D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery*; D002140:California; D017115:Catheter Ablation / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D011336:Probability; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome