title: A survey of expert follow-up practices after successful endoscopic eradication therapy for Barrett's esophagus with high-grade dysplasia and intramucosal adenocarcinoma.
abstract: BACKGROUND
  Despite the increasing number of patients undergoing endoscopic therapy for Barrett's esophagus (BE) with high-grade dysplasia (HGD) or intramucosal cancer (IMC), there are few data to guide clinical decision making and research initiatives in the area of posttreatment follow-up.
  
  
  OBJECTIVE
  We aimed to define expert practice patterns regarding follow-up after endoscopic treatment of BE with HGD and IMC.
  
  
  METHODS
  Electronic survey.
  
  
  METHODS
  Forty-eight endoscopists in the United States with expertise in BE endotherapy based on high-impact publications and national reputation.
  
  
  METHODS
  A 21-item Web-based survey inquiring about post-BE endotherapy follow-up practices.
  
  
  RESULTS
  Of 48 expert endoscopists, 42 completed the survey. After successful treatment of BE with HGD or IMC, all experts perform surveillance upper endoscopy, most commonly at 3-month intervals in the first posttreatment year, every 6 months during the second year, and annually thereafter. None of the experts perform surveillance EUS after treatment of HGD, and only 19% perform EUS after treatment of IMC. After cancer eradication, only 36% of experts refer patients for CT, and 24% refer patients for positron emission tomography. Thirty-eight percent of experts refer patients for a surgical opinion when IMC extends into the muscularis mucosa; 100% refer when IMC extends into submucosa.
  
  
  CONCLUSIONS
  Not a consensus document; only U.S. experts included.
  
  
  CONCLUSIONS
  This study reports the follow-up practices of expert endoscopists after successful endotherapy for BE with HGD and IMC. Additional research is necessary to establish optimal surveillance intervals, the role of follow-up EUS, CT, and positron emission tomography, as well as the surgical implications of low-risk IMC extending into the muscularis mucosa.
authors.affiliation: Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
authors.forename: Aarti O
authors.initials: AO
authors.lastname: Bedi
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
authors.forename: Cyrus R
authors.initials: CR
authors.lastname: Piraka
authors.forename: Grace H
authors.initials: GH
authors.lastname: Elta
authors.forename: James M
authors.initials: JM
authors.lastname: Scheiman
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000359:Aftercare / Q000379:methods*; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D004945:Esophagoscopy / Q000706:statistics & numerical data; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: BE; Barrett's esophagus; HGD; IMC; PET; high-grade dysplasia; intramucosal cancer; positron emission tomography