TY - JOUR
T1 - Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals
AU - Nieuwenhuis, Esther A.
AU - van Munster, Sanne N.
AU - Curvers, Wouter L.
AU - Weusten, Bas L. A. M.
AU - Alvarez Herrero, Lorenza
AU - Bogte, Auke
AU - Alkhalaf, Alaa
AU - Schenk, B. Ed
AU - Koch, Arjun D.
AU - Spaander, Manon C. W.
AU - Tang, Thjon J.
AU - Nagengast, Wouter B.
AU - Westerhof, Jessie
AU - Houben, Martin H. M. G.
AU - Bergman, Jacques J. G. H. M.
AU - Schoon, Erik J.
AU - Pouw, Roos E.
N1 - Funding Information: Dr. Weusten has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, and Aqua Medical. Dr. Bergman has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. The remaining authors declare that they have no conflict of interest. Publisher Copyright: © 2022 The authors.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85128598138&partnerID=8YFLogxK
U2 - https://doi.org/10.1055/a-1754-7309
DO - https://doi.org/10.1055/a-1754-7309
M3 - Article
C2 - 35098524
SN - 0013-726X
VL - 54
SP - 936
EP - 944
JO - Endoscopy
JF - Endoscopy
IS - 10
ER -