title: Practice patterns among U.S. gastroenterologists regarding endoscopic management of Barrett's esophagus.
abstract: BACKGROUND
  Endoscopic management of Barrett's esophagus (BE) has evolved over the past decade; however, the practice patterns for managing BE among gastroenterologists remain unclear.
  
  
  OBJECTIVE
  To assess practice patterns for management of BE among gastroenterologists working in various practice settings.
  
  
  METHODS
  A random questionnaire-based survey of practicing gastroenterologists in the United States. The questionnaire contained a total of 10 questions pertaining to practice setting, physician demographics, and strategies used for managing BE.
  
  
  METHODS
  Survey of gastroenterologists working in various practice settings.
  
  
  METHODS
  Questionnaire.
  
  
  METHODS
  Practice patterns for endoscopic imaging and management of BE.
  
  
  RESULTS
  The response rate was 45% (236/530). The majority (85%) were gastroenterologists in community practice, 72% were aged 41 to 60 years, 80% had >10 years of experience, and 81% had attended postgraduate courses and/or seminars on BE management. A total of 78% did not use the Prague C & M classification, and about a third used advanced endoscopic imaging routinely (37%) or in selected cases (31%). For nondysplastic BE, 86% practiced surveillance, 12% performed ablation, and 3% did no intervention. For BE with low-grade dysplasia, 56% practiced surveillance, 26% performed endoscopic ablation in all low-grade dysplasia cases, and 18% performed endoscopic ablation in only selected patients with low-grade dysplasia. The majority of respondents (58%) referred their patients with high-grade dysplasia to centers with BE expertise, 13% performed endoscopic ablation in all patients with high-grade dysplasia, 25% performed endoscopic ablation in selected cases only, and 3% referred these patients for surgery. The most frequently used endoscopic eradication therapy was radiofrequency ablation (39%) followed by EMR (17%).
  
  
  CONCLUSIONS
  The sample may be unrepresentative, participation in the study was voluntary, and responses may be skewed toward following the guidelines.
  
  
  CONCLUSIONS
  Results from this survey show that the majority of practicing gastroenterologists in the United States practice surveillance endoscopy in patients with nondysplastic BE and provide endoscopic therapy for those with high-grade dysplasia. The Prague C & M classification and advanced imaging techniques are used by less than a third of gastroenterologists. Practice patterns did not appear to be affected by respondent age or duration of clinical practice.
authors.affiliation: Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA; Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Missouri, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Gokulakrishnan
authors.initials: G
authors.lastname: Balasubramanian
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.forename: Preetika
authors.initials: P
authors.lastname: Sinh
authors.forename: Kamran
authors.initials: K
authors.lastname: Aghaie
authors.forename: April D
authors.initials: AD
authors.lastname: Higbee
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Vijay
authors.initials: V
authors.lastname: Kanakadandi
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data; D004945:Esophagoscopy / Q000706:statistics & numerical data*; D005762:Gastroenterology / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011230:Precancerous Conditions / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D014481:United States; D057832:Watchful Waiting / Q000706:statistics & numerical data
keywords: ACG; AGA; ASGE; American College of Gastroenterology; American Gastroenterological Association; American Society for Gastrointestinal Endoscopy; BE; Barrett's esophagus; EAC; HGD; LGD; Prague C & M; Prague circumference (C) and maximum length (M); esophageal adenocarcinoma; high-grade dysplasia; low-grade dysplasia