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CC BY 4.0 · Endoscopy 2022; 54(10): 936-944
DOI: 10.1055/a-1754-7309
Original article

Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitals

Esther A. Nieuwenhuis‡   * 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Sanne N. van Munster‡   * 
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Wouter L. Curvers
 2   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
,
Bas L. A. M. Weusten
 3   Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands
 4   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Lorenza Alvarez Herrero
 3   Department of Gastroenterology and Hepatology, Saint Antonius Hospital, Nieuwegein, The Netherlands
,
Auke Bogte
 4   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Alaa Alkhalaf
 5   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
B. Ed Schenk
 5   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Arjun D. Koch
 6   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Manon C. W. Spaander 
 6   Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Thjon J. Tang
 7   Department of Gastroenterology and Hepatology, IJsselland Hospital, Cappelle aan den Ijssel, The Netherlands
,
Wouter B. Nagengast
 8   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Jessie Westerhof
 8   Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
,
Martin H. M. G. Houben
 9   Department of Gastroenterology and Hepatology, Haga Teaching Hospital, Den Haag, The Netherlands
,
Jacques J.G.H.M. Bergman
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
,
Erik J. Schoon   **
 2   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
10   GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
,
Roos E. Pouw   **
 1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VUMC, Amsterdam, The Netherlands
11   Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, The Netherlands
,
on behalf of the Dutch Barrett Expert Centers › Author Affiliations
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Referred to by:

Centralized care for the management of Barrett’s esophagus: the path forward or just an academic dream?Endoscopy 2022; 54(10): 945-947
DOI: 10.1055/a-1843-9682

Corrected by:

Correction: Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett’s esophagus diagnosed in community hospitalsEndoscopy 2022; 54(10): C15-C15
DOI: 10.1055/a-1914-2490

Abstract

Background The optimal management for patients with low grade dysplasia (LGD) in Barrett’s esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. “confirmed LGD”), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD.

Methods This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC.

Results Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE.

Conclusion One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.

*  Co-first authors.


** Co-senior authors.




Publication History

Received: 31 October 2021

Accepted: 28 January 2022

Accepted Manuscript online:
28 January 2022

Article published online:
31 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet 2009; 373: 850-861
    CrossrefPubMedSearch in Google Scholar
  • 2 Crane LMA, Schaapveld M, Visser O. et al. Oesophageal cancer in The Netherlands: increasing incidence and mortality but improving survival. Eur J Cancer 2007; 43: 1445-1451
    CrossrefPubMedSearch in Google Scholar
  • 3 Solanky D, Krishnamoorthi R, Crews N. et al. Barrett esophagus length, nodularity, and low-grade dysplasia are predictive of progression to esophageal adenocarcinoma. J Clin Gastroenterol 2019; 53: 361-365
    CrossrefPubMedSearch in Google Scholar
  • 4 Klaver E, van der Wel M, Duits L. et al. Performance of gastrointestinal pathologists within a national digital review panel for Barrett’s oesophagus in the Netherlands: results of 80 prospective biopsy reviews. J Clin Pathol 2021; 74: 48-52
    CrossrefPubMedSearch in Google Scholar
  • 5 Klaver E, Bureo Gonzalez A, Mostafavi N. et al. Barrett’s esophagus surveillance in a prospective Dutch multi-centre community-based cohort of 985 patients demonstrates low risk of neoplastic progression. United Eur Gastroenterol J 2021; 9: 929-937
    Search in Google Scholar
  • 6 Duits LC, Phoa KN, Curvers WL. et al. Barrett’s oesophagus patients with low-grade dysplasia can be accurately risk-stratified after histological review by an expert pathology panel. Gut 2015; 64: 700-706
    Search in Google Scholar
  • 7 Curvers WL, ten Kate FJ, Krishnadath KK. et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol 2010; 105: 1523-1530
    Search in Google Scholar
  • 8 Nederlandse Vereniging van Maag-Darm-Leverartsen. Richtlijn Barrett-oesofagus. In Dutch. IKNL; 2018: 1-71 https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/Richtlijnen%20Barrett%20oesofagus%20-%20jan%202018%20-%20tbv%20website.pdf
    PubMedSearch in Google Scholar
  • 9 Weusten B, Bisschops R, Coron E. et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191-198
    Search in Google Scholar
  • 10 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: Diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111: 30-50
    CrossrefPubMedSearch in Google Scholar
  • 11 Evans JA, Early DS. ASGE Standards of Practice Committee. et al. The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 2012; 76: 1087-1094
    CrossrefPubMedSearch in Google Scholar
  • 12 Phoa KN, van Vilsteren FGI, Weusten BLAM. et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia. JAMA 2014; 311: 1209
    Search in Google Scholar
  • 13 Shaheen NJ, Sharma P, Overholt BF. et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277-2288
    CrossrefPubMedSearch in Google Scholar
  • 14 Small AJ, Araujo JL, Leggett CL. et al. Radiofrequency ablation is associated with decreased neoplastic progression in patients with Barrett’s esophagus and confirmed low-grade dysplasia. Gastroenterology 2015; 149: 567-576
    CrossrefPubMedSearch in Google Scholar
  • 15 van Munster S, Nieuwenhuis E, Weusten BLAM. et al. Long-term outcomes after endoscopic treatment for Barrett’s neoplasia with radiofrequency ablation ± endoscopic resection: results from the national Dutch database in a 10-year period. Gut 2022; 71: 265-276
    Search in Google Scholar
  • 16 van der Wel MJ, Duits LC, Klaver E. et al. Development of benchmark quality criteria for assessing whole-endoscopy Barrett’s esophagus biopsy cases. United Eur Gastroenterol J 2018; 6: 830-837
    CrossrefPubMedSearch in Google Scholar
  • 17 van der Wel MJ, Klaver E, Duits LC. et al. Adherence to pre-set benchmark quality criteria to qualify as expert assessor of dysplasia in Barrett’s esophagus biopsies – towards digital review of Barrett’s esophagus. United Eur Gastroenterol J 2019; 7: 889-896
    CrossrefPubMedSearch in Google Scholar
  • 18 Sharma P, Dent J, Armstrong D. et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392-1399
    CrossrefPubMedSearch in Google Scholar
  • 19 The Paris endoscopic classification of superficial neoplastic lesions. Esophagus, stomach, and colon. November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (Suppl. 06) S3-43
    Search in Google Scholar
  • 20 Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1998; 93: 1028-1032
    CrossrefPubMedSearch in Google Scholar
  • 21 Tsoi EH, Mahindra P, Cameron G. et al. Barrett’s esophagus with low-grade dysplasia: high rate of upstaging at Barrett’s esophagus referral units suggests progression rates may be overestimated. Gastrointest Endosc 2021; 94: 902-908
    Search in Google Scholar
  • 22 Bergman JJGHM, de Groof AJ, Pech O. et al. An interactive web-based educational tool improves detection and delineation of Barrett’s esophagus-related neoplasia. Gastroenterology 2019; 156: 1299-1308
    CrossrefPubMedSearch in Google Scholar
  • 23 de Groof AJ, Struyvenberg MR, van der Putten J. et al. Deep-learning system detects neoplasia in patients with Barrett’s esophagus with higher accuracy than endoscopists in a multistep training and validation study with benchmarking. Gastroenterology 2020; 158: 915-929
    CrossrefPubMedSearch in Google Scholar
  • 24 Hvid-Jensen F, Pedersen L, Drewes AM. et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011; 365: 1375-1383
    CrossrefPubMedSearch in Google Scholar
  • 25 Schölvinck DW, van der Meulen K, Bergman JJGHM. et al. Detection of lesions in dysplastic Barrett’s esophagus by community and expert endoscopists. Endoscopy 2017; 49: 113-120
    PubMedSearch in Google Scholar
  • 26 Wani S, Williams JL, Komanduri S. et al. Endoscopists systematically undersample patients with long-segment Barrett’s esophagus: an analysis of biopsy sampling practices from a quality improvement registry. Gastrointest Endosc 2019; 90: 732-741
    Search in Google Scholar
  • 27 Roumans CAM, van der Bogt RD, Steyerberg EW. et al. Adherence to recommendations of Barrett’s esophagus surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2020; 52: 17-28
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Sharma P, Shaheen NJ, Katzka D. et al. AGA clinical practice update on endoscopic treatment of Barrett’s esophagus with dysplasia and/or early cancer: expert review. Gastroenterology 2020; 158: 760-769
    CrossrefPubMedSearch in Google Scholar
  • 29 Wani S, Qumseya B. Standards of Practice Committee. et al. Endoscopic eradication therapy for patients with Barrett’s esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endos 2018; 87: 907-931
    CrossrefPubMedSearch in Google Scholar