Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett's esophagus.
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.


METHODS
Post hoc analysis of data obtained from a clinical trial.


METHODS
Five tertiary referral centers.


METHODS
Patients undergoing BE surveillance.


METHODS
Coordinators prospectively recorded the time spent inspecting the BE mucosa with a stopwatch.


METHODS
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).


CONCLUSIONS
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.
Division of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.
Neil
N
Gupta
Srinivas
S
Gaddam
Sachin B
SB
Wani
Ajay
A
Bansal
Amit
A
Rastogi
Prateek
P
Sharma
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000473:pathology*; D018709:Statistics, Nonparametric; D013997:Time Factors