Premium
Current practice compared with the international guidelines: endoscopic surveillance of Barrett’s esophagus
Author(s) -
Amamra Nassira,
Touzet Sandrine,
Colin Cyrille,
Ponchon Thierry
Publication year - 2007
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/j.1365-2753.2006.00754.x
Subject(s) - medicine , dysplasia , barrett's esophagus , quadrant (abdomen) , general surgery , esophagus , biopsy , family medicine , endoscopy , surgery , cancer , adenocarcinoma
Rationale, aims and objectives To describe the current practice for the surveillance of patients with Barrett’s esophagus, to compare this practice with the national guidelines published by the French Society of Digestive Endoscopy in 1998 and to identify the factors associated with the compliance to guidelines. Method To determine the attitudes of French hepatogastroenterologists to screening for Barrett’s oesophagus, a postal anonymous questionnaire survey was undertaken. It was sent to 246 hepatogastroenterologists in the Rhone‐Alpes area. We defined eight criteria allowed to assess the conformity of practices with the guidelines. We created three topics composed of several criterion. The topics analysed were ‘Biopsies’, ‘Surveillance’ and the diagnosis of high grade dysplasia. We studied the factors which could be associated with the compliance with the guidelines. Results The response rate was 81.3%. For 58.0% of the gastroenterologists, endoscopic biopsy sampling were made according to French guidelines (four‐quadrant biopsies at 2 cm intervals). Agreement was 78.0% regarding the interval of surveillance for no dysplasia (every 2 or 3 years) and 78.5% regarding the low‐grade dysplasia (every 6 or 12 months). For the management of high‐grade dysplasia, 28.6% actually confirm the diagnosis by a second anatomopathologist and 42.0% treated by proton pump inhibitor during 2 months. Concerning the biopsies, the young gastroenterologists and gastroenterologists practising in university hospitals had a better adherence to the guidelines (Relative Risk: 2.22, 95% CI 1.25–3.95 and 3.74, 95% CI 1.04–13.47, respectively). The other factors of risk were not statistically significant. Conclusions The endoscopic follow‐up is mostly realized in accordance with the national guidelines. However, there is a wide variability in individual current practice.