Original articles—alimentary tractAdherence to Biopsy Guidelines for Barrett's Esophagus Surveillance in the Community Setting in the United States
Section snippets
Study Design and Database
We identified patients who underwent surveillance endoscopy for previously diagnosed BE by using a database that had been maintained prospectively by Caris Diagnostics (Irving, TX). This database is derived from all patients referred to Caris Diagnostics, a provider of gastrointestinal pathology services for physicians from community-based freestanding endoscopy centers from 34 states throughout the United States.
We used WinSURGE anatomic pathology software (Computer Trust Corporation, Boston,
Results
Biopsies were received from 278,259 upper endoscopies between January 2002 and April 2007. There were 10,958 cases of BE surveillance performed in 9418 unique patients. Cases were submitted by 668 individual gastroenterologists from 214 community-based endoscopy centers in 34 states. The mean age was 62.3 years (standard deviation, 12.9), and 64.3% of the patients were male.
Endoscopy reports were available and reviewed for 4069 cases (37.1%) (Figure 1). Of these, the length of BE was recorded
Discussion
In this study of a large national community-based pathology database of nearly 11,000 patients with established BE, we found that (1) adherence to the recommended BE surveillance biopsy guidelines in the community is poor, with endoscopists following guidelines only half of the time, and (2) this failure to adhere to the guidelines is associated with reduced detection of dysplasia. These results in and of themselves are not proof that nonadherence to guidelines has an adverse impact on patient
Acknowledgments
Drs Abrams and Kapel contributed equally to this work.
The authors acknowledge the following gastroenterology centers for their participation in the study: Ambulatory Endoscopy of Dallas, Dallas, TX; Arapahoe Gastroenterology, Littleton, CO; Arizona Digestive, Glendale, AZ; Atherton Endoscopy Center, Atherton, CA; Bergen Gastroenterology, Emerson, NJ; Central Maine Endoscopy, Waterville, ME; Charlotte Endoscopy, Port Charlotte, FL; Danbury Surgery Center, Danbury, CT; East Bay Endosurgery Inc,
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To view this article's video abstract, go to the AGA's YouTube Channel.
This article has an accompanying continuing medical education activity on page 710. Learning Objectives—After completing this CME activity, the learner should be able to understand further the epidemiology of Barrett's esophagus and adenocarcinoma, and the impact of adherence to biopsy guidelines for Barrett's esophagus in a community setting.
Conflicts of interest The authors disclose the following: Dr Kapel is a consultant for Caris Diagnostics. Drs Lindberg, Saboorian, and Genta are pathologists for Caris Diagnostics. The remaining authors disclose no conflicts.
Funding Dr Abrams is supported in part by a K07 award from the National Cancer Institute (CA132892). Dr Neugut is supported in part by a grant from the American Cancer Society (RSGT-01-024-04-CPHPS).