Quality indicators for Barrett’s endotherapy (QBET): UK consensus statements for patients undergoing endoscopic therapy for Barrett’s neoplasia

Abstract

IntroductionEndoscopic therapy for the management of patients with Barrett’s oesophagus (BE) neoplasia has significantly developed in the past decade; however, significant variation in clinical practice exists. The aim of this project was to develop expert physician-lead quality indicators (QIs) for Barrett’s endoscopic therapy.MethodsThe RAND/UCLA Appropriateness Method was used to combine the best available scientific evidence with the collective judgement of experts to develop quality indicators for Barrett’s endotherapy in four subgroups: pre-endoscopy, intraprocedure (resection and ablation) and postendoscopy. International experts, including gastroenterologists, surgeons, BE pathologist, clinical nurse specialist and patient representative, participated in a three-round process to develop 15 QIs that fulfilled the RAND/UCLA definition of appropriateness.Results17 experts participated in round 1 and 20 in round 2. Of the 24 proposed QIs in round 1, 20 were ranked as appropriate (put through to round 2) and 4 as uncertain (discarded). At the end of round 2, a final list of 15 QIs were scored as appropriate.ConclusionsThis UK national consensus project has successfully developed QIs for patients undergoing Barrett’s endotherapy. These QIs can be used by service providers to ensure that all patients with BE neoplasia receive uniform and high-quality care.

Endoscopic eradication therapy for Barrett’s esophagus–related neoplasia: a final 10-year report from the UK National HALO Radiofrequency Ablation Registry

“…These data suggest that continuing annual surveillance endoscopies, as recommended by societal guidelines, 20,32 beyond 2 years may offer little additional benefit while providing no evidence that the histologic subtype before EET should be used to guide surveillance intervals. 33 Our findings confirm our previous work in recommending more intense earlier surveillance, which is reduced over time. 34 We may be undertreating those with longer segments of BE.…”

“…In this cohort the risk of stricturing after EET requiring dilatation remained within limits suggested by a consensus publication. 33 In addition, these data must be considered alongside the established literature that reports longer segments of BE typically require more therapy. 35 Some endoscopists have advocated endoscopic submucosal dissection as routine treatment.…”

ASGE guideline on screening and surveillance of Barrett’s esophagus

“…2 This recommendation is in line with other GI society guidelines and quality indicator documents. 4,101 This recommendation should not be confused with the role of EUS in patients with EAC. EUS is indicated in patients with EAC for accurate staging of advanced cancer (T1b) and to evaluate for nodal disease.…”

Factors influencing participation in randomised clinical trials among patients with early Barrett’s neoplasia: a multicentre interview study

“…23 We find that such conditional altruism also entailed an expectation that participation would not be accompanied by personal inconvenience. This finding is particularly relevant for interventions delivered in tertiary centres, as is recommended for the endoscopic management of patients with Barrett's-related Open access neoplasia, 24 and which may involve participants' time and financial sacrifice, as was the case for the BRIDE trial.…”