341 Detection of Lesions in Dysplastic Barrett's Esophagus: Are Expert Endoscopists Doing a Better Job Than Community Endoscopists?

Schölvinck, Dirk W.; Meulen, Kim Van Der; Bergman, Jacques J.; Weusten, Bas L.

doi:10.1016/j.gie.2015.03.1218

Cited by 6 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our results strengthen the advice to obtain an adequate number of random biopsies in BE surveillance endoscopies. This finding is in line with previous research showing that in daily practice, BE patients are still diagnosed with dysplasia by only random biopsies, even after the emergence of high-resolution endoscopes and advanced imaging modalities 25 26 . Non-adherence to the four-quadrant biopsy protocol could subsequently lead to missed diagnosis of dysplasia.…”

Section: Discussionsupporting

confidence: 92%

Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

Background Barrett’s esophagus (BE) surveillance endoscopies are advised for early diagnosis of esophageal adenocarcinoma (EAC). Current guidelines recommend obtaining four-quadrant random biopsies every 2 centimeters of BE length alongside with targeted biopsies if visible lesions are present. Low adherence rates for this random biopsy protocol are widely reported. The aim of this systematic review and meta-analysis was to assess the effect of adherence versus non-adherence to the four-quadrant biopsy protocol on detection of dysplasia in BE patients. Methods We searched for studies that reported effects of adherence and non-adherence to the four-quadrant biopsy protocol on dysplasia detection rates in BE patients. Adherence was defined as taking a minimum of 4 quadrant random biopsies per 2 cm of BE segment. Studies with low risk of bias and without applicability concerns were included in a good quality synthesis. Pooled relative risks (RRs) with 95% confidence interval (CI) of dysplasia detection rates were calculated. Results A total of 1,570 studies were screened and 8 studies were included. Four studies were included in the good quality synthesis. In the pooled good quality analysis, four-quadrant biopsy protocol adherence significantly increased detection of dysplasia compared to non-adherence (RR 1.90, 95 % CI = 1.36–2.64; I2 = 45 %). Pooled RRs for LGD and HGD/EAC were 2.00 (95 % CI = 1.49–2.69; I2 = 0 %) and 2.03 (95 % CI = 0.98–4.24; I2 = 28 %), respectively. Conclusion This systematic review and meta-analysis demonstrates that four-quadrant biopsy protocol adherence is associated with increased detection of dysplasia in BE patients. Efforts should be made to increase biopsy protocol adherence rates.

show abstract

Section: Discussionsupporting

confidence: 92%

Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Expert referral centers have higher rates of detection of HGD/EAC and mucosal abnormalities than community centers, but recognition of subtle lesions containing HGD and early EAC can be challenging in all settings (7, 23). Endoscopic surveillance is effective when done in accordance with practice guidelines, however, adherence to the guidelines varies between settings (23, 24).…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of dysplasia in BE is limited by the random nature of endoscopic sampling, which may miss dysplastic areas, and by inter-observer variation (6). While subtle lesions containing high grade dysplasia (HGD) and EAC can be detected by expert endoscopists at high-volume centers, recognition of subtle lesions is more challenging in the community setting (7). These limitations can result in repeat endoscopies and delayed diagnoses of HGD and EAC (8).…”

Section: Introductionmentioning

confidence: 99%

A Tissue Systems Pathology Test Detects Abnormalities Associated with Prevalent High-Grade Dysplasia and Esophageal Cancer in Barrett's Esophagus

Critchley-Thorne

Davison

Prichard

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

View full text Add to dashboard Cite

Background There is a need for improved tools to detect high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE). In previous work, we demonstrated that a 3-tier classifier predicted risk of incident progression in BE. Our aim was to determine if this risk classifier could detect a field effect in non-dysplastic (ND), indefinite for dysplasia (IND) or low-grade dysplasia (LGD) biopsies from BE patients with prevalent HGD/EAC. Methods We performed a multi-institutional case-control study to evaluate a previously developed risk classifier that is based upon quantitative image features derived from 9 biomarkers and morphology, and predicts risk for HGD/EAC in BE patients. The risk classifier was evaluated in ND, IND and LGD biopsies from BE patients diagnosed with HGD/EAC on repeat endoscopy (prevalent cases, n=30, median time to HGD/EAC diagnosis 140.5 days) and non-progressors (controls, n=145, median HGD/EAC-free surveillance time 2,015 days). Results The risk classifier stratified prevalent cases and non-progressor patients into low-, intermediate- and high-risk classes (odds ratio, 46.0; 95% confidence interval, 14.86–169 (high-risk vs low-risk); p<0.0001). The classifier also provided independent prognostic information that outperformed the subspecialist and generalist diagnosis. Conclusion A tissue systems pathology test better predicts prevalent HGD/EAC in BE patients than pathologic variables. The results indicate that molecular and cellular changes associated with malignant transformation in BE may be detectable as a field effect using the test. Impact A tissue systems pathology test may provide an objective method to facilitate earlier identification of BE patients requiring therapeutic intervention.

show abstract

“…We aimed to determine the effect of endoscopy duration on dysplasia detection. Both endoscopist experience 18 19 and BE length 20 have been shown to influence dysplasia detection. These factors may also impact endoscopy duration.…”

Section: Methodsmentioning

confidence: 99%

The effect of procedural time on dysplasia detection rate during endoscopic surveillance of Barrett’s esophagus

Vithayathil

Modolell

Ortiz-Fernández-Sordo

et al. 2023

Endoscopy

View full text Add to dashboard Cite

Background and Aims: Endoscopic surveillance of Barrett’s esophagus (BE) with Seattle protocol biopsies is time-consuming and inadequately performed in routine practice. There is no recommendation on procedural time for BE surveillance. We investigated the duration of surveillance procedures with adequate tissue sampling and the effect of procedural time on dysplasia detection rate (DDR). Patients and Methods: We performed post-hoc analysis from the standard arm of a cross-over randomized controlled trial recruiting patients with BE ≥C2 and/or ≥M3 and no clearly visible dysplastic lesions. After inspection with white-light imaging, targeted biopsies of subtle lesions and Seattle protocol biopsies were performed. Procedure duration and biopsy number were stratified by BE length. The effect of endoscopy related variables on DDR was assessed by multivariable logistic regression. Results: Of 142 patients recruited, 15 (10.6%) received a diagnosis of high-grade dysplasia/intramucosal cancer and 15 (10.6%) low-grade dysplasia. The median procedural time was 16.5 minutes (IQR 14.0-19.0). We found endoscopy duration increased by 0.9 minutes for additional 1cm of BE length. Seattle protocol biopsies had higher sensitivity for dysplasia compared to targeted biopsies (86.7% vs. 60.0%; p=0.045). Longer procedural time was associated with increased likelihood of dysplasia detection on quadrantic biopsies (OR 1.10, 95%CI 1.00-1.20, p=0.04), and for patients with BE>6cm also on targeted biopsies (OR 1.21, 95% CI 1.04-1.40; p=0.01). Conclusions: In BE patients with no clearly visible dysplastic lesions, longer procedural time is associated with increased likelihood of dysplasia detection. Adequate time slots are required to perform good quality surveillance and maximise dysplasia detection.

show abstract

341 Detection of Lesions in Dysplastic Barrett's Esophagus: Are Expert Endoscopists Doing a Better Job Than Community Endoscopists?

Cited by 6 publications

References 0 publications

Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis

Effect of biopsy protocol adherence vs non-adherence on dysplasia detection rates in Barrett’s esophagus surveillance endoscopies: a systematic review and meta-analysis

A Tissue Systems Pathology Test Detects Abnormalities Associated with Prevalent High-Grade Dysplasia and Esophageal Cancer in Barrett's Esophagus

The effect of procedural time on dysplasia detection rate during endoscopic surveillance of Barrett’s esophagus

Contact Info

Product

Resources

About