Barrett’s Esophagus-Specific Training Improves Adherence to Diagnosis and Treatment Guidelines

Barrett’s Esophagus-Specific Training Improves Adherence to Diagnosis and Treatment Guidelines

Prateek Sharma, MD, FASGE, reviewing Zagari RM, et al. Dig Dis Sci 2021 Sep.

The accurate diagnosis and management of patients with Barrett’s esophagus (BE) are important for the early recognition and minimally invasive treatment of BE neoplasia. Despite international and multisociety guidelines, endoscopist practices vary. 

To evaluate BE management practice patterns among European endoscopists, a questionnaire was sent to all members of the Italian Society of Digestive Endoscopy (SIED; n=883), resulting in a 31.1% (n=259) response rate. Of the respondents, 65.6% had more than 10 years of experience, 42.9% were older than age 50, and 68.8% practiced in a community hospital. Within the last 5 years, 61% had attended a training course on BE. 

The majority of respondents reported using the Prague classification to measure the extent of disease (82.9%) and the Seattle protocol to collect tissue samples (84.4%). Only 65.5% of respondents used the top of the gastric folds to determine the location of the gastroesophageal junction (GEJ), whereas 27.1% used the Z line, 5.9% the distal end of the palisade vessels, and 1.6% the diaphragmatic hiatus. A total of 88.3% of respondents indicated intestinal metaplasia needed to be present for a BE diagnosis. Approximately half of the respondents (51.4%) routinely used advanced endoscopic imaging techniques, including high-definition endoscopy, narrow-band imaging, autofluorescence imaging, and confocal laser endomicroscopy. A few (29.4%) used advanced imaging only if there was a concern of dysplasia or cancer. The timing of BE endoscopic surveillance varied: 69.2% evaluated every 3 to 5 years, 23.3% every 2 years, and 6.7% every year. 

On multivariate analysis, specific training in BE (within the past 5 years) was associated with improved diagnosis and management through the use of the Prague criteria (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.9-12.1; P=.001), the gastric folds as a GEJ landmark (OR, 2.45; 95% CI, 1.27-4.74; P=.008), and advanced endoscopic imaging techniques (OR, 3.33; 95% CI, 1.53-7.29; P=.003).

Prateek Sharma, MD, FASGE

COMMENT

Practice patterns in the diagnosis and management of BE vary despite multiple guidelines endorsing the use of validated measures for endoscopic extent (Prague criteria), appropriate recognition of the GEJ, and the use of advanced imaging techniques. These parameters can improve if endoscopists attend BE-specific educational and training courses.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Zagari RM, Eusebi LH, Galloro G, et al. Attending training courses on Barrett’s esophagus improves adherence to guidelines: a survey from the Italian Society of Digestive Endoscopy. Dig Dis Sci 2021;66:2888- 2896. (https://doi.org/10.1007/s10620-020-06615-6)

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