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Digestive Diseases and Sciences

, Volume 63, Issue 12, pp 3262–3271 | Cite as

A Survey of Expert Practice and Attitudes Regarding Advanced Imaging Modalities in Surveillance of Barrett’s Esophagus

  • Jorge D. Machicado
  • Samuel Han
  • Rena H. Yadlapati
  • Violette C. Simon
  • Bashar J. Qumseya
  • Shahnaz Sultan
  • Vladimir M. Kushnir
  • Sri Komanduri
  • Amit Rastogi
  • V. Raman Muthusamy
  • Rehan Haidry
  • Krish Ragunath
  • Rajvinder Singh
  • Hazem T. Hammad
  • Nicholas J. Shaheen
  • Sachin WaniEmail author
Original Article
  • 126 Downloads

Abstract

Background

Published guidelines do not address what the minimum incremental diagnostic yield (IDY) for detection of dysplasia/cancer is required over the standard Seattle protocol for an advanced imaging modality (AIM) to be implemented in routine surveillance of Barrett’s esophagus (BE) patients. We aimed to report expert practice patterns and attitudes, specifically addressing the minimum IDY in the use of AIMs in BE surveillance.

Methods

An international group of BE experts completed an anonymous electronic survey of domains relevant to surveillance practice patterns and use of AIMs. The evaluated AIMs were conventional chromoendoscopy (CC), virtual chromoendoscopy (VC), volumetric laser endomicroscopy (VLE), confocal laser endomicroscopy (CLE), and wide-area transepithelial sampling (WATS3D). Responses were recorded using five-point balanced Likert items and analyzed as continuous variables.

Results

The survey response rate was 84% (61/73)—41 US and 20 non-US. Experts were most comfortable with and routinely use VC and CC, and least comfortable with and rarely use VLE, CLE, and WATS3D. Experts rated data from randomized controlled trials (1.4 ± 0.9) and guidelines (2.6 ± 1.2) as the two most influential factors for implementing AIMs in clinical practice. The minimum IDY of AIMs over standard biopsies to be considered of clinical benefit was lowest for VC (15%, IQR 10–29%) and highest for VLE (30%, IQR 20–50%). Compared to US experts, non-US experts reported higher use of CC for BE surveillance (p < 0.001).

Conclusion

These results should inform benchmarks that need to be met for guidelines to recommend the routine use of AIMs in the surveillance of BE patients.

Keywords

Barrett’s esophagus Surveillance Advanced imaging modalities Practice patterns 

Notes

Acknowledgments

This study was supported by the University of Colorado Department of Medicine Outstanding Early Scholars Program. SK is a consultant for Boston Scientific and Medtronic; AR is a consultant for Olympus, Research support–Olympus; HH is a consultant Medtronic; SW is a consultant for Boston Scientific and Medtronic.

Author’s contribution

Jorge D. Machicado, Samuel Han, Nicholas J. Shaheen, and Sachin B. Wani were involved in study concept and design. Jorge D. Machicado, Samuel Han, Violette C. Simon, and Sachin B. Wani were involved in acquisition of data. Jorge D. Machicado contributed to statistical analysis. Jorge D. Machicado and Sachin B. Wani drafted the manuscript. All authors were involved in data interpretation, review of manuscript for important intellectual content, final approval of the manuscript. Guarantor of the article: Sachin Wani, MD.

Compliance with ethical standards

Conflict of interest

The other authors declare no conflicts of interest.

Supplementary material

10620_2018_5257_MOESM1_ESM.pdf (65 kb)
Supplementary material 1 (PDF 64 kb)
10620_2018_5257_MOESM2_ESM.docx (32 kb)
Supplementary material 2 (DOCX 31 kb)

References

  1. 1.
    Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet. 2013;381:400–412.CrossRefGoogle Scholar
  2. 2.
    Cameron AJ, Carpenter HA. Barrett’s esophagus, high-grade dysplasia, and early adenocarcinoma: a pathological study. Am J Gastroenterol. 1997;92:586–591.PubMedGoogle Scholar
  3. 3.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  4. 4.
    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. (quiz 51).CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Verbeek RE, Leenders M, Ten Kate FJ, et al. Surveillance of Barrett’s esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study. Am J Gastroenterol. 2014;109:1215–1222.CrossRefGoogle Scholar
  7. 7.
    Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–e52. (quiz e13).CrossRefGoogle Scholar
  8. 8.
    Fujiwara S, Yao K, Nagahama T, et al. Can we accurately diagnose minute gastric cancers (≤ 5 mm)? Chromoendoscopy (CE) vs magnifying endoscopy with narrow band imaging (M-NBI). Gastric Cancer. 2015;18:590–596.CrossRefGoogle Scholar
  9. 9.
    Abela JE, Going JJ, Mackenzie JF, et al. Systematic four-quadrant biopsy detects Barrett’s dysplasia in more patients than nonsystematic biopsy. Am J Gastroenterol. 2008;103:850–855.CrossRefGoogle Scholar
  10. 10.
    Falk GW, Rice TW, Goldblum JR, et al. Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 1999;49:170–176.CrossRefGoogle Scholar
  11. 11.
    Wani S, Gaddam S. Editorial: best practices in surveillance of Barrett’s esophagus. Am J Gastroenterol. 2017;112:1056–1060.CrossRefGoogle Scholar
  12. 12.
    Abrams JA, Kapel RC, Lindberg GM, et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol. 2009;7:736–742 (quiz 710).CrossRefGoogle Scholar
  13. 13.
    Boerwinkel DF, Swager A, Curvers WL, et al. The clinical consequences of advanced imaging techniques in Barrett’s esophagus. Gastroenterology. 2014;146:622–629 (e624).CrossRefGoogle Scholar
  14. 14.
    Sharma P, Savides TJ, Canto MI, et al. The American Society for Gastrointestinal Endoscopy PIVI (preservation and incorporation of valuable endoscopic innovations) on imaging in Barrett’s esophagus. Gastrointest Endosc. 2012;76:252–254.CrossRefGoogle Scholar
  15. 15.
    Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.CrossRefGoogle Scholar
  16. 16.
    Lubke G, Muthen B. Applying multigroup confirmatory factor models for continuous outcomes to Likert scale data complicates meaningful group comparisons. Struct Equ Model. 2004;11:514–534.CrossRefGoogle Scholar
  17. 17.
    Kara MA, Peters FP, Rosmolen WD, et al. High-resolution endoscopy plus chromoendoscopy or narrow-band imaging in Barrett’s esophagus: a prospective randomized crossover study. Endoscopy. 2005;37:929–936.CrossRefGoogle Scholar
  18. 18.
    Hoffman A, Korczynski O, Tresch A, et al. Acetic acid compared with i-scan imaging for detecting Barrett’s esophagus: a randomized, comparative trial. Gastrointest Endosc. 2014;79:46–54.CrossRefGoogle Scholar
  19. 19.
    Sharma P, Bansal A, Mathur S, et al. The utility of a novel narrow band imaging endoscopy system in patients with Barrett’s esophagus. Gastrointest Endosc. 2006;64:167–175.CrossRefGoogle Scholar
  20. 20.
    Kara MA, Ennahachi M, Fockens P, et al. Detection and classification of the mucosal and vascular patterns (mucosal morphology) in Barrett’s esophagus by using narrow band imaging. Gastrointest Endosc. 2006;64:155–166.CrossRefGoogle Scholar
  21. 21.
    Singh R, Anagnostopoulos GK, Yao K, et al. Narrow-band imaging with magnification in Barrett’s esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy. 2008;40:457–463.CrossRefGoogle Scholar
  22. 22.
    Sharma P, Bergman JJ, Goda K, et al. Development and validation of a classification system to identify high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus using narrow-band imaging. Gastroenterology. 2016;150:591–598.CrossRefGoogle Scholar
  23. 23.
    Hultcrantz M, Rind D, Akl EA, et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol. 2017;87:4–13.CrossRefGoogle Scholar
  24. 24.
    Committee AT, Thosani N, Abu Dayyeh BK, et al. ASGE Technology Committee systematic review and meta-analysis assessing the ASGE preservation and incorporation of valuable endoscopic innovations thresholds for adopting real-time imaging-assisted endoscopic targeted biopsy during endoscopic surveillance of Barrett’s esophagus. Gastrointest Endosc. 2016;83:684–698 (e687).CrossRefGoogle Scholar
  25. 25.
    Coletta M, Sami SS, Nachiappan A, et al. Acetic acid chromoendoscopy for the diagnosis of early neoplasia and specialized intestinal metaplasia in Barrett’s esophagus: a meta-analysis. Gastrointest Endosc. 2016;83:57–67 (e51).CrossRefGoogle Scholar
  26. 26.
    Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013;11:e1561–e1562.CrossRefGoogle Scholar
  27. 27.
    Qumseya BJ, Gendy S, Qumsiyeh Y, et al. Marginal increase in dysplasia detection and very high false positive rate for volumetric laser endomicroscopy in Barrett’s esophagus: systemic review and meta-analysis. Gastrointest Endosc. 2017;85:AB554.CrossRefGoogle Scholar
  28. 28.
    Vennalaganti PR, Kaul V, Wang KK, et al. Increased detection of Barrett’s esophagus-associated neoplasia using wide-area trans-epithelial sampling: a multicenter, prospective, randomized trial. Gastrointest Endosc. 2017.  https://doi.org/10.1016/j.gie.2017.07.039.CrossRefPubMedGoogle Scholar
  29. 29.
    Canto MI, Anandasabapathy S, Brugge W, et al. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc. 2014;79:211–221.CrossRefGoogle Scholar
  30. 30.
    Singh M, Gupta N, Gaddam S, et al. Practice patterns among U.S. gastroenterologists regarding endoscopic management of Barrett’s esophagus. Gastrointest Endosc. 2013;78:689–695.CrossRefGoogle Scholar
  31. 31.
    Dunn SJ, Neilson LJ, Hassan C, et al. ESGE Survey: worldwide practice patterns amongst gastroenterologists regarding the endoscopic management of Barrett’s esophagus. Endosc Int Open. 2016;4:E36–E41.CrossRefGoogle Scholar
  32. 32.
    Olliver JR, Wild CP, Sahay P, et al. Chromoendoscopy with methylene blue and associated DNA damage in Barrett’s oesophagus. Lancet. 2003;362:373–374.CrossRefGoogle Scholar
  33. 33.
    Appannagari A, Soudagar AS, Pietrzak C, et al. Are gastroenterologists willing to implement imaging-guided surveillance for Barrett’s esophagus? Results from a national survey. Endosc Int Open. 2015;3:E181–E185.CrossRefGoogle Scholar
  34. 34.
    Wani S, Muthusamy VR, Shaheen NJ, et al. Development of quality indicators for endoscopic eradication therapies in Barrett’s esophagus: the TREAT-BE (treatment with resection and endoscopic ablation techniques for Barrett’s esophagus) consortium. Am J Gastroenterol. 2017;112:1032–1048.CrossRefGoogle Scholar
  35. 35.
    Wani S, Muthusamy VR, Shaheen NJ, et al. Development of quality indicators for endoscopic eradication therapies in Barrett’s esophagus: the TREAT-BE (treatment with resection and endoscopic ablation techniques for Barrett’s esophagus) consortium. Gastrointest Endosc. 2017;86:1–17 (e13).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jorge D. Machicado
    • 1
  • Samuel Han
    • 1
  • Rena H. Yadlapati
    • 1
  • Violette C. Simon
    • 1
  • Bashar J. Qumseya
    • 2
  • Shahnaz Sultan
    • 3
  • Vladimir M. Kushnir
    • 4
  • Sri Komanduri
    • 5
  • Amit Rastogi
    • 6
  • V. Raman Muthusamy
    • 7
  • Rehan Haidry
    • 8
  • Krish Ragunath
    • 9
  • Rajvinder Singh
    • 10
  • Hazem T. Hammad
    • 1
  • Nicholas J. Shaheen
    • 11
  • Sachin Wani
    • 1
    Email author
  1. 1.University of Colorado Anschutz Medical CenterAuroraUSA
  2. 2.Archbold Medical CenterThomasvilleUSA
  3. 3.Minneapolis VA Health Care SystemMinneapolisUSA
  4. 4.Washington UniversitySt. LouisUSA
  5. 5.Northwestern UniversityChicagoUSA
  6. 6.University of Kansas School of MedicineKansas CityUSA
  7. 7.University of California in Los AngelesLos AngelesUSA
  8. 8.University College HospitalLondonUK
  9. 9.University of NottinghamNottinghamUK
  10. 10.University of AdelaideAdelaideAustralia
  11. 11.University of North CarolinaChapel HillUSA

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