title: Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate.
abstract: Background and study aimBarrett's esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR).Patients and methodsThis was a prospective study of patients undergoing BE surveillance at two hospitals - community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett's surveillance over the preceding 5-year period.ResultsA total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (P< 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A.ConclusionThis study demonstrated that a group of trained endoscopists undertaking Barrett's surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett's surveillance lists.
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ooi
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wilson
authors.affiliation: Department of Gastroenterology, Lewisham University Hospital, London, United Kingdom.
authors.forename: Giles
authors.initials: G
authors.lastname: Walker
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Blaker
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Sabina
authors.initials: S
authors.lastname: DeMartino
authors.affiliation: Department of Gastroenterology, Lewisham University Hospital, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: O'Donohue
authors.affiliation: Department of Gastroenterology, Lewisham University Hospital, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Reffitt
authors.affiliation: Department of Histopathology, Lewisham University Hospital, London, United Kingdom.
authors.forename: Effie
authors.initials: E
authors.lastname: Lanaspre
authors.affiliation: Department of Histopathology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Fuju
authors.initials: F
authors.lastname: Chang
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Meenan
authors.affiliation: Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.|Institute of Medical Informatics, Oslo University Hospital, Norway.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Dunn
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D001471:Barrett Esophagus / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D004945:Esophagoscopy / Q000193:education*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D057832:Watchful Waiting / Q000458:organization & administration / Q000592:standards*