Systematic review with meta‐analysis: neoplasia detection rate and post‐endoscopy Barrett's neoplasia in Barrett's oesophagus

Hamade, Nour; Kamboj, Amrit K.; Krishnamoorthi, Rajesh; Singh, Siddharth; Hassett, Leslie; Katzka, David A.; Kahi, Charles J.; Fatima, Hala; Iyer, Prasad G.

doi:10.1111/apt.16531

Cited by 7 publications

(8 citation statements)

References 46 publications

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“…In another cohort of 13 159 patients diagnosed with high-grade dysplasia or esophageal adenocarcinoma, 12.7% (34/267) were identified within 3 to 12 months after Barrett esophagus diagnosis and were considered to have possibly been missed during index endoscopy, with 25% of these occurring among patients with Barrett esophagus with low-grade dysplasia and 9% occurring among those with nondysplastic Barrett esophagus . To improve detection of dysplasia, a neoplasia detection rate (rate of high-grade dysplasia or esophageal adenocarcinoma detection during initial surveillance endoscopy) is recommended as a validated quality measure for endoscopic evaluation of patients with Barrett esophagus, with data indicating that every 1% increase of neoplasia detection rate leads to a clinically relevant 3.5% decrease in the rate of later diagnosis of Barrett esophagus neoplasia presumed to have been missed at the index endoscopy …”

Section: Progression Of Barrett Esophagus To Esophageal Adenocarcinomamentioning

confidence: 99%

Barrett Esophagus

Sharma

2022

JAMA

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ImportanceBarrett esophagus is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia and affects approximately 5% of people in the US and approximately 1% worldwide. Approximately 3% to 5% of patients with Barrett esophagus will be diagnosed with esophageal adenocarcinoma in their lifetime.ObservationsBarrett esophagus affects approximately 2.3% to 8.3% of people with gastroesophageal reflux disease (GERD) and approximately 1.2% to 5.6% of people without GERD. Characteristics associated with Barrett esophagus include older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger), male sex, and smoking (prevalence of approximately 12% in people who smoke cigarettes compared with 1.1% in those who do not smoke cigarettes). The histopathology of Barrett esophagus progresses from metaplasia to dysplasia and, without treatment, can progress to adenocarcinoma. People with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing esophageal adenocarcinoma. Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years. In patients with Barrett esophagus and dysplasia or early cancer, endoscopic therapy consisting of resection and ablation successfully treats 80% to 90% of patients.Conclusions and RelevanceBarrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide and is associated with an increased risk of esophageal adenocarcinoma. First-line therapy for Barrett esophagus consists of proton-pump inhibitors for control of reflux symptoms, but their role in chemoprevention is unclear. Surveillance with upper endoscopy is recommended by practice guidelines to monitor for progression to esophageal adenocarcinoma, but randomized clinical trials are lacking.

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Section: Progression Of Barrett Esophagus To Esophageal Adenocarcinomamentioning

confidence: 99%

Barrett Esophagus

Sharma

2022

JAMA

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“…Recent reported NDRs have ranged from 4.9% to 7.0%. 6,[12][13][14] This measurement was developed akin to the concept of the adenoma detection rate (ADR) in colonoscopy, which reflects the quality and effectiveness of the examination. ADR is a percentage of colonoscopic examinations where polyps (adenomas) were detected in comprehensive examinations.…”

Section: Neoplasia Detection Rate (Ndr)mentioning

confidence: 99%

“…Despite these limitations, NDR and the development of Barrett's neoplastic lesions may have an inverse relationship. In a systematic review that analyzed 10 studies of 27,894 patients, Hamade et al 13 showed that for every 1% increase in the NDR, there was a 3.5% reduction in Barrett's neoplastic lesion identified in the postfollow-up endoscopy. This study has been the only one to currently demonstrate the inverse relationship, but this finding has not yet been supported by other studies.…”

Section: Issues With Ndr As a Qimentioning

confidence: 99%

“…The latest American Gastroenterological Association clinical practice update states that this period should be within the first 6 months after an index endoscopy with negative histology results. 23 However, an aforementioned review by Hamade et al 13 and another systematic review that analyzed 52 studies of 145,726 patients by Sawas et al 24 25 defined this period as between 30 and 365 days after index endoscopy that had negative histology results for EAC. In contrast, Desai et al 6 considered the PEBN to be the cases of BE neoplasia found within 7-36 months after index endoscopy in which no EAC was detected histologically according to the PCCRC concept.…”

Section: Postendoscopy Barrett's Neoplasia (Pebn) Ratementioning

confidence: 99%

“…6 In addition to the different timeframe of the postendoscopy, the numerator for calculating the PEBN differs across studies. For example, Desai et al 6 included those who developed EAC, while Hamade et al 13 included those with HGD as well as EAC. Sawas et al 24 calculated the PEBN in two ways: postendoscopy EAC and postendoscopy EAC/ HGD.…”

Section: Postendoscopy Barrett's Neoplasia (Pebn) Ratementioning

confidence: 99%

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Quality indicators in Barrett's endoscopy: Best is yet to come

Inoue

Ragunath

2023

Digestive Endoscopy

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There is growing interest in establishing quality indicators (QIs) for endoscopic screening and surveillance in Barrett's esophagus (BE). QIs are objective, measurable, and evidence‐based metrics that are applicable in a healthcare setting to monitor a process and identify key performance indicators (KPI) to achieve defined goals. In the Barrett's endoscopy setting, QIs can offer a standardised approach to monitor and maintain high‐quality endoscopy for BE screening and surveillance that will allow measuring performance of an endoscopist as an individual, a group, or a facility. Since BE is an endoscopically identifiable premalignant condition with histological corroboration, adherence to QIs is paramount for the early and accurate detection of dysplasia and neoplasia. It is the holy grail for BE screening and surveillance. Although several suggested QIs for Barrett's endoscopy exist, issues remain in determining the most appropriate ones. These issues include inconsistent use of terminology, unclear definitions, and a scarcity of studies linking these QIs with relevant patient outcomes, making it difficult for clinicians to understand the concept and clinical importance. Hence, there is an urgent need to determine what should constitute appropriate QIs for Barrett's endoscopy, clearly define items used in the QIs, and identify ways to measure these KPIs. Ultimately, well‐defined and validated QIs will contribute to clinically effective, safe, timely, and patient‐focused care. In this review, we summarize recent literature and discuss about four proposed QIs: 1) neoplasia detection rate (NDR), 2) post endoscopy Barrett's neoplasia (PEBN), 3) Barrett's inspection time, and 4) adherence to the Seattle biopsy protocol.

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