Detection of lesions in dysplastic Barrett's esophagus by community and expert endoscopists
Background and aims Endoscopic treatment of Barrett’s esophagus (BE) consists of endoscopic resection of visible lesions followed by radiofrequency ablation (RFA) for any remaining flat BE. Because RFA is only justified in flat BE, detection of neoplastic lesions (high grade dysplasia [HGD] and early adenocarcinoma [EAC]) is crucial. We hypothesized that the detection of visible lesions containing HGD or EAC would be superior in BE expert centers compared with community hospitals, thereby supporting centralization of therapy for BE-related neoplasia.Methods Patients referred with histologically proven HGD or EAC to two Dutch BE expert centers were included. Referral letters, and endoscopy and pathology reports were reviewed for the description of the BE, presence of lesions, and histopathological analysis of target and random tissue sampling. Primary outcome was the endoscopic detection rate of lesions containing histopathologically proven neoplasia (HGD and/or EAC) in community and expert centers.Results There were 198 patients referred from 37 community hospitals (median referral time 55 days [interquartile range 33 – 85]). Detection rates for visible lesions were 60 % in community centers (75 % in patients with a biopsy diagnosis of EAC, 47 % in HGD) and 87 % in expert centers (98 % in EAC, 75 % in HGD); P
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