Trends in the diagnosis and monitoring of barretts esophagus

Ramji, A.; Chaun, H.; Halparin, L.; Amar, J.; Whittaker, J. S. ott; Enns, R.

Barrett's esophagus is a premalignant mucosal change for which surveillance recommendations have been developed. Objective: To assess the changing practices in the diagnosis and monitoring of Barrett's esophagus (BE), and to determine if these changes have resulted in increased findings of dysplasia. Methods: All patients with biopsy-proven BE from 1995-2001 at a teaching hospital in British Columbia were reviewed and divided into 2 groups; Group 1: prior to publication of the 1998 American Association of Gastroenterologists guidelines on Barrett's esophagus (1995-1998), and Group 2: those undergoing endoscopies after publication (1999-2001). Endoscopies were examined for: identification of endoscopic landmarks, comment on presence/or absence of esophagitis and hiatus hernia (HH), length of BE, and quality of biopsy methods. Biopsy number was deemed adequate if more than 4 biopsies were taken every 2 cm. of endoscopically-identified BE. In patients with no endoscopic Barrett's, 3 or more biopsies was considered adequate. Patients were also followed for dysplasia. Univariate analysis was performed utilizing the chi-square and student t-test methods, SPSS version 11.0. Results: BE was biopsy-proven in 401 endoscopies (222 pts). Of these, 171 (43%) were prior to the guidelines (mean age 58 yrs, 77% male). Short-segment BE was more often diagnosed in Group 2, 49% vs. 33% (p=0.002). In assessment of biopsies, Group 2 had a greater proportion of adequate number of biopsies (44% vs. 10%), p<0.001, or 7 (CI 95% 3.8-13). In cases with no endoscopically-identified BE, Group 2 again had a higher proportion of adequate number of biopsies (85% vs. 50%), p=0.002, or 5.6 (CI 95% 1.8-17). Esophagitis was more frequently commented on in Group 2, 45% vs. 22% (p<0.001). There was no difference on comment on HH. Twenty patients were diagnosed with dysplasia (13 high-grade). There was no significant difference in the numbers of patients diagnosed with dysplasia between the groups. Conclusion: Diagnosis and monitoring for BE has improved since the publication of the1998 American Association of Gastroenterologists guidelines. There has been increased recognition of short segment BE. Despite the improvement in practices there has been no difference in the diagnosis of dysplasia.