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Neoplasia Detection Rate in Barrett’s Esophagus: A Measure of High-Quality Upper Endoscopy

Prateek Sharma, MD, FASGE, reviewing Dhaliwal L, et al. Clin Gastroenterol Hepatol 2020 Jul 21.

Studies have reported that up to 25% of esophageal adenocarcinomas (EACs) are detected within 1 year of index endoscopy (missed cancer), emphasizing the need for high-quality endoscopy in patients with Barrett’s esophagus (BE). Recent studies have proposed the use of the neoplasia detection rate ([NDR] the percentage of patients with BE who have high-grade dysplasia [HGD] or EAC on screening endoscopy) as a quality measure akin to the adenoma detection rate used in colonoscopies. The aim of this population-based cohort study was to estimate NDR and its effect on missed dysplasia. 

In this study of 1066  patients, (72% male; mean age, 63 years; mean BE length, 3.6 cm), the authors reported an NDR of 4.9% (3.1% with HGD and 1.8% with EAC). Higher rates of NDR were associated with male gender, older age, BE length, smoking history, and endoscopy conducted by gastroenterologists. Of note, gastroenterologists had a substantially higher rate of neoplasia detection than nongastroenterologists (5.8% vs 1.7%; P=.0098). Furthermore, significantly more visible lesions within the BE segment were reported by gastroenterologists compared to nongastroenterologists (odds ratio [OR], 3.7; P=.0120). The estimated missed dysplasia (dysplasia detected within 1 year of index endoscopy) in this cohort was 13% (lower than previous reports). There was no significant difference between patients with and without missed dysplasia with regard to length of BE (P=.4), adherence to the Seattle protocol (P=.8), visible lesion (OR, 0.6; 95% confidence interval, 0.11-3.25), age, smoking history, or endoscopist specialty.

Prateek Sharma, MD, FASGE

COMMENT

Performing a high-quality examination in patients with BE is critical. Monitoring NDR may be an objective measurement of such high-quality endoscopy. Upper endoscopy performed by gastroenterologists is associated with a higher NDR and increased detection of visible lesions.

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)

Dhaliwal L, Codipilly DC, Gandhi P, et al. Neoplasia detection rate (NDR) in Barrett’s esophagus and its impact on missed dysplasia: results from a large population-based database. Clin Gastroenterol Hepatol 2020 Jul 21. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.07.034)

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