title: Are gastroenterologists willing to implement imaging-guided surveillance for Barrett's esophagus? Results from a national survey.
abstract: BACKGROUND
  The American Society for Gastrointestinal Endoscopy (ASGE) has published a Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) statement on incorporating an imaging-guided surveillance protocol to replace the current practice of four-quadrant biopsies every two centimeters for Barrett's esophagus (BE) surveillance. We sought to determine if current gastroenterologists would be willing to apply these changes to their practice and identify any barriers to implementation.
  
  
  METHODS
  We collected data using surveys that were distributed at two national meetings and using a random selection process emailed surveys to members listed in the American Gastroenterological Association directory. Physicians from a variety of practice settings participated. Primary outcomes of our study included determining whether clinicians would be willing to accept an imaging-based surveillance protocol, their reasons for not doing so, and whether a financial incentive would be persuade them to implement the protocol. Continuous variables were reported as mean ± standard deviation. Categorical variables were summarized with percentages and 95 % confidence intervals.
  
  
  RESULTS
  Gastroenterologists (172) completed the survey; and 140 (81.4 %) of them stated they would implemented the PIVI recommendations into practice. Using a multivariate analysis of the data, physicians who reported a financial incentive for submitting biopsy specimens to pathology were less likely to implement the PIVI recommendations. The two main barriers to implementation of the protocol were medical-legal and financial reasons. Of the 32 gastroenterologists who were not willing to implement the imaging-guided surveillance protocol, 20 (62.5 %) stated that they would implement it if there were a financial incentive.
  
  
  CONCLUSIONS
  The PIVI statement focuses on re-evaluating our current method of surveillance for BE. The results of our survey show that gastroenterologists may be willing to implement an imaging-guided surveillance program, but concerns regarding financial compensation and proper training in advanced imaging techniques remain.
authors.affiliation: Loyola University Medical Center, Department of Gastroenterology, Maywood, Illinois, United States.
authors.forename: Anoop
authors.initials: A
authors.lastname: Appannagari
authors.affiliation: Loyola University Medical Center, Department of Gastroenterology, Maywood, Illinois, United States.
authors.forename: A Samad
authors.initials: AS
authors.lastname: Soudagar
authors.affiliation: Loyola University Medical Center, Department of Gastroenterology, Maywood, Illinois, United States.
authors.forename: Constance
authors.initials: C
authors.lastname: Pietrzak
authors.affiliation: University of Kansas Medical Center, Department of Gastroenterology, Kansas City, Kansas, United States.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Loyola University Medical Center, Department of Gastroenterology, Maywood, Illinois, United States.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta