Optimum Barrett’s Inspection Time Is Critical for a High-Quality Endoscopy
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Optimum Barrett’s Inspection Time Is Critical for a High-Quality Endoscopy

Prateek Sharma, MD, FASGE, reviewing Vithayathil M, et al. Endoscopy 2023 Jan 19.

Endoscopic surveillance of Barrett’s esophagus (BE) is recommended to reduce mortality and morbidity related to esophageal adenocarcinoma. A thorough endoscopic inspection of a BE segment and obtaining Seattle protocol biopsies take significantly longer procedural time, and this likely explains the low adherence to guidelines and poor quality of endoscopic surveillance. However, guidelines do not specify the optimal inspection time for BE surveillance (BIT).

The study investigated the duration of endoscopic surveillance procedures for BE and its effect on the dysplasia detection rate. The study was a post hoc analysis of a crossover, randomized, controlled trial with 142 patients with BE ≥C2 and/or ≥M3 and no visible dysplastic lesions. 

The median procedure time was 16.5 minutes, and the duration of the procedure increased by 0.9 minutes for each additional 1 cm of BE length. The study found that a longer procedure time was associated with an increased likelihood of dysplasia detection and that Seattle protocol biopsies were more sensitive than targeted biopsies for detecting dysplasia. A longer BIT was associated with an increased likelihood of dysplasia detection on biopsies (odds ratio, 1.10; 95% confidence interval, 1.00-1.20; P=.04).

Prateek Sharma, MD, FASGE

COMMENT

To ensure the realization of the full potential of BE surveillance and improved patient outcomes, it is crucial that the inspection time during surveillance procedures be standardized. This will allow adequate time for endoscopists to obtain samples of and thoroughly inspect the diseased mucosa. The BIT should be considered a quality metric for BE endoscopy.

 

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Vithayathil M, Modolell I, Ortiz-Fernández-Sordo’ J, et al. Longer procedural time increases the dysplasia detection rate during endoscopic surveillance of Barrett’s esophagus. Endoscopy 2022 Jan 19. (Epub ahead of print) (https://doi.org/10.1055/a-2015-8883)

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