Management of Patients with Barrett’s Esophagus and High Grade Dysplasia
Barrett’s esophagus is sometimes complicated by high grade dysplasia. This survey was designed to inform readers about current practices in surveillance for and management of this problem. For purposes of this survey, respondents were asked to assume that they were referred a healthy middle aged patient who had been diagnosed with Barrett’s esophagus. The patient had undergone endoscopy by a gastroenterologist showing no evidence for cancer, and reflux symptoms were well controlled on acid suppression therapy.
The number of respondents was low, suggesting that most readers are not actively managing patients with Barrett’s esophagus. Of those responding, the majority are involved in managing such patients. It is widely believed among respondents that antireflux surgery reduces the risk of high grade dysplasia developing in Barrett’s mucosa. All respondents agree on the need for endoscopic surveillance in patients with Barrett’s esophagus. There is considerable disagreement regarding the likelihood of invasive cancer being present when HGD is diagnosed, with more than 50% of respondents believing the risk is 20% or less. Repeat endoscopy and EUS are the most common procedures recommended when HGD is identified. For patients with confirmed HGD, two-thirds of respondents believe esophagectomy is the appropriate therapy, which is in contrast to the fact that most respondents believe the risk of cancer is less than 20%.
| 1. Do you manage patients with Barrett's
esophagus? |
| |
Response
Percent |
Response
Count |
|
Yes
|
|
83.3%
|
35
|
|
No
|
|
16.7%
|
7
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 2. Do you believe that fundoplication surgery
can help prevent the development of high grade dysplasia in Barrett's
mucosa? |
| |
Response
Percent |
Response
Count |
|
Yes
|
|
64.3%
|
27
|
|
No
|
|
35.7%
|
15
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 3. Should patients with Barrett's esophagus
undergo surveillance endoscopy periodically? |
| |
Response
Percent |
Response
Count |
|
Yes
|
|
100.0%
|
42
|
|
No
|
|
0.0%
|
0
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 4. When high grade dysplasia is identified
in Barrett's mucosa, what is the likelihood that a patient will have
invasive adenocarcinoma at that point in time? |
| |
Response
Percent |
Response
Count |
|
10%
|
|
26.2%
|
11
|
|
20%
|
|
26.2%
|
11
|
|
30%
|
|
23.8%
|
10
|
|
40% or more
|
|
23.8%
|
10
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 5. If Barrett's high grade dysplasia is identified,
check all tests or procedures you normally use for further evaluation
at the time of diagnosis: |
| |
Response
Percent |
Response
Count |
|
Repeat endoscopy (including any associated techniques such as chromoendoscopy,
high resolution endoscopy, etc.)
|
|
33.3%
|
14
|
|
CT scan
|
|
14.3%
|
6
|
|
PET scan
|
|
11.9%
|
5
|
|
EUS
|
|
33.3%
|
14
|
|
EMR
|
|
7.1%
|
3
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 6. If Barrett's high grade dysplasia is confirmed
and the patient is healthy, what do you most often recommend for initial
management? |
| |
Response
Percent |
Response
Count |
|
Esophagectomy
|
|
66.7%
|
28
|
|
EMR or other ablative procedure
|
|
19.0%
|
8
|
|
Observation with close surveillance
|
|
14.3%
|
6
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
| 7. In what region is your surgical practice
based? |
| |
Response
Percent |
Response
Count |
|
North America
|
|
61.9%
|
26
|
|
Europe
|
|
26.2%
|
11
|
|
South America
|
|
0.0%
|
0
|
|
Asia
|
|
7.1%
|
3
|
|
Africa
|
|
4.8%
|
2
|
|
|
answered question |
42
|
|
|
skipped question |
0
|
