Adherence to quality indicators in endoscopic surveillance of Barrett's esophagus and correlation to dysplasia detection rates

Antony, Andrew; Pohanka, Charles J.; Keogh, Susan; Klein, Robert M.; Alshelleh, Mohammad; Lee, Calvin; Trindade, Arvind J.

doi:10.1016/j.clinre.2018.06.004

Cited by 16 publications

(13 citation statements)

References 17 publications

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“…When practitioners comply with documenting endoscopic landmarks and the Prague classification, a significant increase in dysplasia detection rate is observed. 64 The Los Angeles classification should be used to describe the appearance and grade of severity of erosive esophagitis during endoscopy. Agreement: Aþ, 50%; A, 47%; U, 3%; D, 0%; Dþ, 0%…”

Section: %mentioning

confidence: 99%

Rio de Janeiro Global Consensus on Landmarks, Definitions, and Classifications in Barrett’s Esophagus: World Endoscopy Organization Delphi Study

et al. 2022

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Section: %mentioning

confidence: 99%

Rio de Janeiro Global Consensus on Landmarks, Definitions, and Classifications in Barrett’s Esophagus: World Endoscopy Organization Delphi Study

et al. 2022

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“…This rigorous approach has led to a significant increase in detection of early lesions . However, in clinical practice, this approach is often time‐consuming and labor‐intensive leading to poor adherence . Foci of dysplasia may also be missed .…”

Section: Recent Advances In Diagnostic Surveillance In Be Dysplasiamentioning

confidence: 99%

“…59 However, in clinical practice, this approach is often time-consuming and labor-intensive leading to poor adherence. 60,61 Foci of dysplasia may also be missed. 62 In a survey of Asian expert endoscopists, only 30% adhered to this protocol.…”

Section: Recent Advances In Diagnostic Surveillance In Be Dysplasiamentioning

confidence: 99%

Challenges to diagnostic standardization of Barrett's esophagus in Asia

Soh

Lee

Gotoda

et al. 2019

Digestive Endoscopy

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Barrett's esophagus (BE), a premalignant condition of the lower esophagus, is increasingly prevalent in Asia. However, endoscopic and histopathological criteria vary widely between studies across Asia, making it challenging to assess comparability between geographical regions. Furthermore, guidelines from various societies worldwide provide differing viewpoints and definitions, leading to diagnostic challenges that affect prognostication of the condition. In this review, the authors discuss the controversies surrounding the diagnosis of BE, particularly in Asia. Differences between guidelines worldwide are summarized with further discussion regarding various classifications of BE used, different definitions of gastroesophageal junction used across geographical regions and the clinical implications of intestinal metaplasia in the setting of BE. Although many guidelines recommend the Seattle protocol as the preferred approach regarding dysplasia surveillance in BE, some limitations exist, leading to poor adherence. Newer technologies, such as acetic acid‐enhanced magnification endoscopy, narrow band imaging, Raman spectroscopy, molecular approaches and the use of artificial intelligence appear promising in addressing these problems, but further studies are required before implementation into routine clinical practice. The Asian Barrett's Consortium also outlines its ongoing plans to tackle the challenge of standardizing the diagnosis of BE in Asia.

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“…Currently risk stratification for the progression to esophageal adenocarcinoma is determined by the presence of dysplasia [2]; however, dysplasia within a BE segment is often focal and not widespread [3]. Therefore, it is important that a meticulous endoscopic examination is performed in order to help detect dysplasia, if present [4,5]. In addition to a detailed examination with high definition white-light endoscopy, advanced imaging tools exists that can aid in the detection of BE [6 -9].…”

Section: Introductionmentioning

confidence: 99%

Spatial distribution of dysplasia in Barrett’s esophagus segments before and after endoscopic ablation therapy: a meta-analysis

et al. 2020

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Background: Dysplasia in Barrett’s esophagus is focal and difficult to locate. The aim of this meta-analysis was to understand the spatial distribution of dysplasia in Barrett’s esophagus before and after endoscopic ablation therapy. Methods: A systematic search was performed of multiple databases to July 2019. The location of dysplasia prior to ablation was determined using a clock face orientation (right or left half of the esophagus). The location of dysplasia post-ablation was classified as within the tubular esophagus or at the top of the gastric folds (TGF). Results: Thirteen studies with 2234 patients were identified. Pooled analysis from 6 studies (819 lesions in 802 patients) showed that before ablation, dysplasia was more commonly located in the right half versus the left half (OR 4.3; 95% CI [2.33-7.93]; p<0.01). Pooled analysis from 7 studies showed that dysplasia after ablation recurred in 101/1432 (7.05%; 95% CI [5.7-8.4%]) patients. Recurrence of dysplasia was located more commonly at the TGF (n=68) as compared to the tubular esophagus (n=34) (OR 5.33; 95% CI [1.75-16.21]; p<0.01). Of the esophageal lesions, 90% (27/30) were visible whereas only 46% (23/50) of the recurrent dysplastic lesions at TGF were visible (p<0.01). Conclusion: Before ablation, dysplasia in Barrett’s esophagus is found more frequently in the right half of the esophagus versus the left. Post-ablation recurrence is more commonly found in the top of the gastric folds and is non-visible as compared to the tubular esophagus, which is mainly visible.

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Adherence to quality indicators in endoscopic surveillance of Barrett's esophagus and correlation to dysplasia detection rates

Cited by 16 publications

References 17 publications

Rio de Janeiro Global Consensus on Landmarks, Definitions, and Classifications in Barrett’s Esophagus: World Endoscopy Organization Delphi Study

Rio de Janeiro Global Consensus on Landmarks, Definitions, and Classifications in Barrett’s Esophagus: World Endoscopy Organization Delphi Study

Challenges to diagnostic standardization of Barrett's esophagus in Asia

Spatial distribution of dysplasia in Barrett’s esophagus segments before and after endoscopic ablation therapy: a meta-analysis

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