In the Journals

Undersampling ‘concerning’ in Barrett’s screening

Data from the GI Quality Improvement Consortium Registry revealed that some endoscopists are not collecting enough samples when performing systematic biopsies for Barrett’s esophagus, particularly in longer lesions where the sampling is most useful.

Sachin Wani, MD, of the division of gastroenterology and hepatology at the University of Colorado Anschutz Medical Center, and colleagues wrote in Gastrointestinal Endoscopy that systematic biopsy — known as the Seattle protocol — helps improve detection, but adherence to its practice has been unclear.

“Despite this emphasis on appropriate sampling using the Seattle biopsy protocol during surveillance endoscopy, there are limited data as to whether endoscopists are following these guidelines in clinical practice,” they wrote. “Population-based estimates of adherence to this recommendation are limited, given that few large databases have matched endoscopy and pathology data.”

The Seattle protocol uses 4-quadrant biopsies at 2-cm intervals in patients without dysplasia and 1-cm intervals in patients with prior dysplasia, as well as targeted biopsies from any mucosal abnormality.

Wani and colleagues analyzed data from the GIQuIC registry — like procedure indications, as well as endoscopy and pathology results — to assess adherence to the protocol. They divided BE length by number of pathology jars, with a ratio of 2 or less rounding down (lenient definition) or rounding up (stringent definition) for odd BE lengths to judge adherence.

A total of 58,709 esophagogastroduodenoscopies (EGD) in 53,541 patients met the inclusion criteria of indication of BE screening/surveillance or an endoscopic finding of BE.

When they used the lenient definition, researchers found that 87.8% of EGDs were adherent compared with 82.7% when using the stringent definition. Increasing length of BE was the biggest predictor of adherence (OR = 0.69; 95% CI, 0.67–0.71). For every 1-cm increase in BE length, nonadherence increased by 31%.

Nonadherence was also linked to increasing patient age and endoscopies performed by non-GI physicians.

Wani and colleagues wrote that they found their findings “concerning,” because BE length is linked to dysplasia detection.

“Per unit length, patients who need it the most are being biopsied the least,” they wrote. “These results can be used to plan future intervention studies to ensure that all endoscopists perform high-value surveillance endoscopies and ultimately improve the effectiveness of surveillance in BE patients.” – by Alex Young

Disclosures: Wani reports consulting for Bostin Scientific and Medtronic. Please see the full study for all other authors’ relevant financial disclosures.

Data from the GI Quality Improvement Consortium Registry revealed that some endoscopists are not collecting enough samples when performing systematic biopsies for Barrett’s esophagus, particularly in longer lesions where the sampling is most useful.

Sachin Wani, MD, of the division of gastroenterology and hepatology at the University of Colorado Anschutz Medical Center, and colleagues wrote in Gastrointestinal Endoscopy that systematic biopsy — known as the Seattle protocol — helps improve detection, but adherence to its practice has been unclear.

“Despite this emphasis on appropriate sampling using the Seattle biopsy protocol during surveillance endoscopy, there are limited data as to whether endoscopists are following these guidelines in clinical practice,” they wrote. “Population-based estimates of adherence to this recommendation are limited, given that few large databases have matched endoscopy and pathology data.”

The Seattle protocol uses 4-quadrant biopsies at 2-cm intervals in patients without dysplasia and 1-cm intervals in patients with prior dysplasia, as well as targeted biopsies from any mucosal abnormality.

Wani and colleagues analyzed data from the GIQuIC registry — like procedure indications, as well as endoscopy and pathology results — to assess adherence to the protocol. They divided BE length by number of pathology jars, with a ratio of 2 or less rounding down (lenient definition) or rounding up (stringent definition) for odd BE lengths to judge adherence.

A total of 58,709 esophagogastroduodenoscopies (EGD) in 53,541 patients met the inclusion criteria of indication of BE screening/surveillance or an endoscopic finding of BE.

When they used the lenient definition, researchers found that 87.8% of EGDs were adherent compared with 82.7% when using the stringent definition. Increasing length of BE was the biggest predictor of adherence (OR = 0.69; 95% CI, 0.67–0.71). For every 1-cm increase in BE length, nonadherence increased by 31%.

Nonadherence was also linked to increasing patient age and endoscopies performed by non-GI physicians.

Wani and colleagues wrote that they found their findings “concerning,” because BE length is linked to dysplasia detection.

“Per unit length, patients who need it the most are being biopsied the least,” they wrote. “These results can be used to plan future intervention studies to ensure that all endoscopists perform high-value surveillance endoscopies and ultimately improve the effectiveness of surveillance in BE patients.” – by Alex Young

Disclosures: Wani reports consulting for Bostin Scientific and Medtronic. Please see the full study for all other authors’ relevant financial disclosures.