Adherence to guideline recommendations for Barrett's esophagus (BE) surveillance endoscopies: Effects of dedicated BE endoscopy lists

I N Beaufort; A N Milne; Y A Alderlieste; J E Baars; P R Bos; J P W Burger; N C M van Heel; M Ledeboer; R J Lieverse; P C van de Meeberg; J J Meeuse; A H J Naber; H J M Pullens; R C H Scheffer; M Sikkema; R E Verbeek; M A M T Verhagen; W van de Vrie; M Willems; B L A M Weusten

doi:10.1055/a-2125-0161

Adherence to guideline recommendations for Barrett's esophagus (BE) surveillance endoscopies: Effects of dedicated BE endoscopy lists

Endosc Int Open. 2023 Oct 11;11(10):E952-E962. doi: 10.1055/a-2125-0161. eCollection 2023 Oct.

Authors

I N Beaufort^{1

2}, A N Milne³, Y A Alderlieste⁴, J E Baars⁵, P R Bos⁶, J P W Burger⁷, N C M van Heel⁸, M Ledeboer⁹, R J Lieverse¹⁰, P C van de Meeberg¹¹, J J Meeuse¹², A H J Naber¹³, H J M Pullens¹⁴, R C H Scheffer¹⁵, M Sikkema¹⁶, R E Verbeek¹⁷, M A M T Verhagen¹⁸, W van de Vrie¹⁹, M Willems²⁰, B L A M Weusten^{1

2}

Affiliations

¹ Department of Gastroenterology and Hepatology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands.
² Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands.
³ Department of Pathology, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands.
⁴ Department of Gastroenterology and Hepatology, Beatrixziekenhuis, Gorinchem, Netherlands.
⁵ Department of Gastroenterology and Hepatology, Amphia Ziekenhuis, Breda, Netherlands.
⁶ Department of Gastroenterology and Hepatology, Ziekenhuis Gelderse Vallei, Ede, Netherlands.
⁷ Department of Gastroenterology and Hepatology, Rijnstate, Arnhem, Netherlands.
⁸ Department of Gastroenterology and Hepatology, Gelre Ziekenhuizen, Apeldoorn, Netherlands.
⁹ Department of Gastroenterology and Hepatology, Deventer Ziekenhuis, Deventer, Netherlands.
¹⁰ Department of Gastroenterology and Hepatology, Ziekenhuisgroep Twente, Almelo, Netherlands.
¹¹ Department of Gastroenterology and Hepatology, Slingeland Ziekenhuis, Doetinchem, Netherlands.
¹² Department of Internal Medicine, Ziekenhuis Rivierenland, Tiel, Netherlands.
¹³ Department of Gastroenterology and Hepatology, Tergooi MC, Hilversum, Netherlands.
¹⁴ Department of Gastroenterology and Hepatology, Meander MC, Amersfoort, Netherlands.
¹⁵ Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Netherlands.
¹⁶ Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands.
¹⁷ Department of Gastroenterology and Hepatology, Groene Hart Ziekenhuis, Gouda, Netherlands.
¹⁸ Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, Netherlands.
¹⁹ Department of Gastroenterology and Hepatology, Albert Schweitzer Ziekenhuis, Dordrecht, Netherlands.
²⁰ Department of Gastroenterology and Hepatology, Ziekenhuis Sint Jansdal, Harderwijk, Netherlands.

Abstract

Background and study aims For non-dysplastic Barrett's Esophagus (BE) patients, guidelines recommend endoscopic surveillance every 3 to 5 years with four-quadrant random biopsies every 2 cm of BE length. Adherence to these guidelines is low in clinical practice. Pooling BE surveillance endoscopies on dedicated endoscopy lists performed by dedicated endoscopists could possibly enhance guideline adherence, detection of visible lesions, and dysplasia detection rates (DDRs). Patients and methods Data were used from the ACID-study (Netherlands Trial Registry NL8214), a prospective trial of BE surveillance in the Netherlands. BE patients with known or previously treated dysplasia were excluded. Guideline adherence, detection of visible lesions, and DDRs were compared for patients on dedicated and general endoscopy lists. Results A total of 1,244 patients were included, 318 on dedicated lists and 926 on general lists. Endoscopies on dedicated lists showed significantly higher adherence to the random biopsy protocol (85% vs. 66%, P <0.01) and recommended surveillance intervals (60% vs. 47%, P <0.01) compared to general lists. Detection of visible lesions (8.8% vs. 8.1%, P =0.79) and DDRs were not significantly different (6.9% and 6.6%, P =0.94). None (0.0%) of the patients scheduled on dedicated lists and 10 (1.1%) on general lists were diagnosed with esophageal adenocarcinoma ( P =0.07). In multivariable analysis, dedicated lists were significantly associated with biopsy protocol adherence and adherence to surveillance interval recommendations with odds ratios of 4.45 (95% confidence interval [CI] 2.07-9.57) and 1.64 (95% CI 1.03-2.61), respectively. Conclusions Dedicated endoscopy lists are associated with better adherence to the random biopsy protocol and surveillance interval recommendations.

Keywords: Barrett's and adenocarcinoma; Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE); Endoscopy Upper GI Tract; Reflux disease.

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