title: Detection of lesions in dysplastic Barrett's esophagus by community and expert endoscopists.
abstract: Background and aimsEndoscopic treatment of Barrett's esophagus (BE) consists of endoscopic resection of visible lesions followed by radiofrequency ablation (RFA) for any remaining flat BE. Because RFA is only justified in flat BE, detection of neoplastic lesions (high grade dysplasia [HGD] and early adenocarcinoma [EAC]) is crucial. We hypothesized that the detection of visible lesions containing HGD or EAC would be superior in BE expert centers compared with community hospitals, thereby supporting centralization of therapy for BE-related neoplasia.MethodsPatients referred with histologically proven HGD or EAC to two Dutch BE expert centers were included. Referral letters, and endoscopy and pathology reports were reviewed for the description of the BE, presence of lesions, and histopathological analysis of target and random tissue sampling. Primary outcome was the endoscopic detection rate of lesions containing histopathologically proven neoplasia (HGD and/or EAC) in community and expert centers.ResultsThere were 198 patients referred from 37 community hospitals (median referral time 55 days [interquartile range 33 - 85]). Detection rates for visible lesions were 60 % in community centers (75 % in patients with a biopsy diagnosis of EAC, 47 % in HGD) and 87 % in expert centers (98 % in EAC, 75 % in HGD);P< 0.001. Even with HGD/EAC on random biopsies from the index endoscopy, the yield at repeat endoscopy was < 50 % in community hospitals. In 79 patients referred solely because of random biopsy results, a lesion requiring endoscopic resection or surgery was found in 76 % by the expert endoscopists.ConclusionsEndoscopists at community hospitals detect neoplastic lesions at a significantly lower rate. These data support the value of BE expert centers for work-up and further treatment of BE.
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands.|Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Schölvinck
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: van der Meulen
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJGHM
authors.lastname: Bergman
authors.affiliation: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands.|Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Bas L A M
authors.initials: BLAM
authors.lastname: Weusten
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D017115:Catheter Ablation / Q000379:methods; D018450:Disease Progression; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D015203:Reproducibility of Results