Endoscopy in Barrett's oesophagus: adherence to standards and neoplasia detection in the community practice versus hospital setting.
OBJECTIVE
Potential process differences between hospital and community-based endoscopy for Barrett's oesophagus have not been examined. We aimed at comparing adherence to guidelines and neoplasia detection rates in medical centres (MC) and community practices (CP).


METHODS
Retrospective analysis.


METHODS
All histologically confirmed Barrett cases seen over a 3-year period in six MC and 19 CP covering a third of all upper gastrointestinal endoscopies (n = 126,000) performed annually in Berlin, Germany.


METHODS
Rate of relevant neoplasia (high-grade intraepithelial neoplasia or more) in both settings in relation to adherence to standards.


RESULTS
Of 1317 Barrett cases, 66% were seen in CP. CP patients had a shorter mean Barrett length (2.6 cm vs. 3.8 cm; P < 0.001) with fewer biopsies taken during an examination (2.5 vs. 4.1 for Barrett length <or=2 cm; P < 0.001). CPs also provided fewer complete esophagogastroduodenoscopy documentation (25.1% vs. 57.8%, P < 0.001). Neoplasias were found more commonly in MCs compared to CPs (9.2% vs. 0.8%; P < 0.001). However, on exclusion of all referred patients with known neoplasia (65%) or those examined for other reasons (27.5%), the detection rate at MCs decreased to 1.3%, not different from the one seen at CPs (0.8%, P = 0.43). Only 13% were found during surveillance, but 57% were diagnosed at an early stage.


CONCLUSIONS
Referral bias and not better adherence to guidelines could explain the higher neoplasia prevalence in Barrett's oesophagus at hospital centres. Despite a generally poor adherence to guidelines, most neoplasias found were at an early and potentially curable stage.
Pohl
H
H
Department of Gastroenterology, Charité University Hospitals, Berlin, Germany. heiko.pohl@dartmouth.edu
Aschenbeck
J
J
Drossel
R
R
Schröder
A
A
Mayr
M
M
Koch
M
M
Rothe
K
K
Anders
M
M
Voderholzer
W
W
Hoffmann
J
J
Schulz
H-J
HJ
Liehr
R-M
RM
Gottschalk
U
U
Wiedenmann
B
B
Rösch
T
T
D000230:Adenocarcinoma / Q000473:pathology; D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis*; D001604:Berlin; D002278:Carcinoma in Situ / Q000473:pathology; D003153:Community Health Services / Q000592:standards; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods / Q000592:standards*; D005194:Family Practice / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis; D012189:Retrospective Studies