Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

Shen, Emily F.; Gladstone, Steve R.; Milne, G.; Paterson-Brown, Simon; Penman, Ian

doi:10.1177/003693300304800205

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Multiple gastroenterology societies recommend such strategies for patients with symptoms of gastroesophageal reflux disease (GERD) (3)(4)(5)(6), but the practice remains controversial due to the unproven efficacy of screening, the limited impact that such a program would have on the burden of disease in the population, only modest ability to predict which patients will develop cancer, and the poor long-term survival from all but intramucosal esophageal cancer (7)(8)(9)(10). In practice, a wide range of surveillance patterns for patients with documented Barrett's esophagus has been reported among gastroenterologists (11)(12)(13)(14)(15)(16), but there has been little published regarding the practice patterns of initial screening (17). Furthermore, little is known regarding the factors that may influence practice patterns of individual gastroenterologists.…”

Section: Introductionmentioning

confidence: 99%

Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Rubenstein

Saini

Kuhn

et al. 2008

Am J Gastroenterology

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Section: Introductionmentioning

confidence: 99%

Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Rubenstein

Saini

Kuhn

et al. 2008

Am J Gastroenterology

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“…Previously, two studies have also combined both a survey, endoscopy, and pathology reports, but the survey was not among the endoscopists who performed the endoscopies and could therefore not be directly correlated. 14,15 Also, in the literature, studies were most often performed in univariable analysis; we used multivariable analysis. 5 There are several limitations to our study.…”

Section: Discussionmentioning

confidence: 99%

Clinical consequences of nonadherence to Barrett’s esophagus surveillance recommendations: a Multicenter prospective cohort study

Roumans

Bogt

Nieboer

et al. 2022

Diseases of the Esophagus

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Half of Barrett’s esophagus (BE) surveillance endoscopies do not adhere to guideline recommendations. In this multicenter prospective cohort study, we assessed the clinical consequences of nonadherence to recommended surveillance intervals and biopsy protocol. Data from BE surveillance patients were collected from endoscopy and pathology reports; questionnaires were distributed among endoscopists. We estimated the association between (non)adherence and (i) endoscopic curability of esophageal adenocarcinoma (EAC), (ii) mortality, and (iii) misclassification of histological diagnosis according to a multistate hidden Markov model. Potential explanatory parameters (patient, facility, endoscopist variables) for nonadherence, related to clinical impact, were analyzed. In 726 BE patients, 3802 endoscopies were performed by 167 endoscopists. Adherence to surveillance interval was 16% for non-dysplastic (ND)BE, 55% for low-grade dysplasia (LGD), and 54% of endoscopies followed the Seattle protocol. There was no evidence to support the following statements: longer surveillance intervals or fewer biopsies than recommended affect endoscopic curability of EAC or cause-specific mortality (P > 0.20); insufficient biopsies affect the probability of NDBE (OR 1.0) or LGD (OR 2.3) being misclassified as high-grade dysplasia/EAC (P > 0.05). Better adherence was associated with older patients (OR 1.1), BE segments ≤ 2 cm (OR 8.3), visible abnormalities (OR 1.8, all P ≤ 0.05), endoscopists with a subspecialty (OR 3.2), and endoscopists who deemed histological diagnosis an adequate marker (OR 2.0). Clinical consequences of nonadherence to guidelines appeared to be limited with respect to endoscopic curability of EAC and mortality. This indicates that BE surveillance recommendations should be optimized to minimize the burden of endoscopies.

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“…Only 5% of respondents recommended a surveillance interval of 3 years for this group [14]. Surveys of physicians in Canada [16], Ireland [17], Scotland [18], and the Netherlands [19] reveal similar results, with wide variation in practice patterns and generally poor reported adherence to published guidelines. To our knowledge, this is the first published study to measure whether patient factors may be associated with increased frequency of endoscopic surveillance in BE.…”

Section: Discussionmentioning

confidence: 99%

Overutilization of endoscopic surveillance in nondysplastic Barrett's esophagus: a multicenter study

Crockett

Lipkus

Bright

et al. 2012

Gastrointestinal Endoscopy

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Background Guidelines suggest that patients with non-dysplastic BE undergo endoscopic surveillance every 3–5 years, but actual utilization of surveillance endoscopy and the determinants of variation in surveillance intervals are not known. Objective To measure utilization of surveillance endoscopy and its variation in patients with non-dysplastic BE. Design Multi-center, cross-sectional study Setting Three sites in Arizona, Minnesota, and North Carolina. Patients Participants had prevalent BE without a history of high grade dysplasia or EAC. Interventions Participants were given validated measures of quality of life, numeracy, and cancer risk perception, and the total number of prior endoscopic surveillance exams was measured. Main outcome measurements Over-surveillance was defined as >1 surveillance exam per 3 year period. Results Among 235 patients with non-dysplastic BE, 76% were male and 94% Caucasian. The average duration of BE was 6.5 years (± 5.9 years). The mean number of endoscopies per 3 year period was 2.7 (± 2.6 years). Over-surveillance was present in 65% of participants, resulting in a mean of 2.3 excess endoscopies per patient. Neither numeracy skills nor patient perception of cancer risk were associated with over-surveillance. Limitations Endoscopies were measured by patient report, which is subject to error. Results may only be generalizable to patients seen in academic centers. Conclusions Most patients with non-dysplastic BE had more surveillance endoscopic exams than is recommended by published guidelines. Patient factors did not predict over-surveillance, indicating that other factors may influence decisions about the interval and frequency of surveillance exams.

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Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

Cited by 3 publications

References 16 publications

Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Influence of Malpractice History on the Practice of Screening and Surveillance for Barrett's Esophagus

Clinical consequences of nonadherence to Barrett’s esophagus surveillance recommendations: a Multicenter prospective cohort study

Overutilization of endoscopic surveillance in nondysplastic Barrett's esophagus: a multicenter study

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