Clinical variation in surveillance and management of Barrett’s esophagus: A cross-sectional study of gastroenterologists and gastrointestinal surgeons

Appropriate surveillance and treatment of Barrett’s esophagus (BE) is vital to prevent disease progression and decrease esophageal adenocarcinoma (EAC)-related mortality. We sought to determine the variation in BE care and identify improvement opportunities. 275 physicians (113 general gastroenterol...

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Bibliographic Details
Published in:	Medicine (Baltimore) Vol. 101; no. 51; p. e32187
Main Authors:	Cruz, Jamielyn DC, Paculdo, David, Ganesan, Divya, Baker, Meredith, Critchley-Thorne, Rebecca J, Shaheen, Nicholas J, Wani, Sachin, Peabody, John W
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins 23-12-2022
Subjects:	Barrett Esophagus - diagnosis Barrett Esophagus - pathology Barrett Esophagus - therapy Cross-Sectional Studies Disease Progression Esophageal Neoplasms - diagnosis Gastroenterologists Humans Hyperplasia Observational Study Precancerous Conditions - diagnosis Precancerous Conditions - pathology Precancerous Conditions - therapy Surgeons
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Summary:	Appropriate surveillance and treatment of Barrett’s esophagus (BE) is vital to prevent disease progression and decrease esophageal adenocarcinoma (EAC)-related mortality. We sought to determine the variation in BE care and identify improvement opportunities. 275 physicians (113 general gastroenterologists, 128 interventional gastroenterologists, 34 gastrointestinal surgeons) cared for 3 simulated patients, one each from 3 BE clinical scenariosnon-dysplastic BE (NDBE), BE indefinite for dysplasia (IND), and BE with low grade dysplasia (LGD), and care scores were measured against societal guidelines. Overall quality-of-care scores ranged from 17% to 85% with mean of 47.9% ± 11.8% for NDBE, 50.8% ± 11.7% for IND, and 52.7% ± 12.2% for LGD. Participants appropriately determined risk of progression 20.3% of the time14.4% for NDBE cases, 19.9% for LGD cases, and 26.8% for IND cases (P = .001). Treatment and follow-up care scores averaged 12.9% ± 17.5% overall. For the LGD cases, guideline-recommended twice-daily PPI treatment was ordered only 24.7% of the time. Guideline-based follow-up endoscopic surveillance was done in only 27.7% of NDBE cases and 32.7% of IND cases. For the LGD cases, 45.4% ordered endoscopic eradication therapy while 25.1% chose annual endoscopic surveillance. Finally, participants provided counseling on lifestyle modifications in just 20% of cases. Overall care of patients diagnosed with BE varied widely and showed room for improvement. Specific opportunities for improvement were adherence to guideline recommended surveillance intervals, patient counseling, and treatment selection for LGD. Physicians would potentially benefit from additional BE education, endoscopic advances, and better methods for risk stratification.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1536-5964 0025-7974 1536-5964
DOI:	10.1097/MD.0000000000032187