title: Adherence to therapy for Barrett's esophagus-associated neoplasia.
abstract: OBJECTIVE
  Multiple endoscopic sessions may be necessary for treatment and surveillance of Barrett's esophagus (BE)-associated neoplasia. Adherence to an endoscopic therapeutic regimen is important for longitudinal management of BE. The objective of this study was to identify the factors associated with adherence to therapy for BE-associated neoplasia.
  
  
  METHODS
  We retrospectively identified patients with BE whom were referred to a tertiary center for endoscopic mucosal resection (EMR) or radiofrequency ablation (RFA) between 2009 and 2012. Demographic and clinical data were extracted from the medical record.
  
  
  RESULTS
  We had 69 subjects meet our inclusion criteria. Referral diagnosis was low-grade dysplasia in 9 (13%) subjects, high-grade dysplasia in 33 (48%) subjects and adenocarcinoma in 26 (38%) subjects. The majority (55%) lived more than 100 miles from the treatment center. The primary third-party payer was US Medicare for 54% of the subjects and private insurance for 36% of them; 45% of the subjects were seen in the clinic by the treating endoscopist, prior to endoscopic therapy and 71% underwent EMR as the initial treatment, while 29% underwent RFA without prior EMR. We found that 72% of subjects were adherent to therapy, including: 23 (33%) completing endoscopic therapy with documented post-treatment surveillance, 18 (26%) with ongoing endoscopic therapy, and 9 (13%) whom underwent esophagectomy. Subjects seen in gastroenterology clinical consultation were significantly more likely to demonstrate adherence than those referred for open access endoscopy (Lasso OR 2.31).
  
  
  CONCLUSIONS
  Patients seen in a clinical consultation prior to endoscopic therapy for BE-associated neoplasia were more likely to demonstrate treatment adherence, compared to patients referred for open-access endoscopy. A clinic visit prior to therapy may define expectations regarding treatment course and increase the likelihood of patient adherence.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cassani
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Slaughter
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yachimski
keywords: Adherence; Barrett's esophagus; endoscopic mucosal resection; esophageal cancer; radiofrequency ablation