Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals

Esther Nieuwenhuis; Sanne van Munster; Wouter L Curvers; Bas L A M Weusten; Lorenza Alvarez Herrero; Auke Bogte; Alaa Alkhalaf; B E Schenk; Arjun Dave Koch; Manon C W Spaander; Thjon J Tang; Wouter B Nagengast; Jessie Westerhof; Martin H M G Houben; Jacques Jghm Bergman; Erik J Schoon; Roos E Pouw

doi:10.1055/a-1754-7309

Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals

Esther Nieuwenhuis, Sanne van Munster, Wouter L Curvers, Bas L A M Weusten, Lorenza Alvarez Herrero, Auke Bogte, Alaa Alkhalaf, B E Schenk, Arjun Dave Koch, Manon C W Spaander, Thjon J Tang, Wouter B Nagengast, Jessie Westerhof, Martin H M G Houben, Jacques Jghm Bergman, Erik J Schoon, Roos E Pouw

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND : The optimal management for patients with low grade dysplasia (LGD) in Barrett's esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. "confirmed LGD"), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD. METHODS : This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC. RESULTS : Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE. CONCLUSION : One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.

Original language	English
Pages (from-to)	936-944
Number of pages	9
Journal	Endoscopy
Volume	54
Issue number	10
Early online date	28 Jan 2022
DOIs	https://doi.org/10.1055/a-1754-7309
Publication status	Published - 1 Oct 2022

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Nieuwenhuis, E., van Munster, S., Curvers, W. L., Weusten, B. L. A. M., Alvarez Herrero, L., Bogte, A., Alkhalaf, A., Schenk, B. E., Koch, A. D., Spaander, M. C. W., Tang, T. J., Nagengast, W. B., Westerhof, J., Houben, M. H. M. G., Bergman, J. J., Schoon, E. J., & Pouw, R. E. (2022). Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals. Endoscopy, 54(10), 936-944. https://doi.org/10.1055/a-1754-7309

@article{2c1774bca9694630a8ab423b3454d78c,

title = "Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals",

abstract = "BACKGROUND : The optimal management for patients with low grade dysplasia (LGD) in Barrett's esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. {"}confirmed LGD{"}), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD. METHODS : This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC. RESULTS : Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE. CONCLUSION : One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.",

author = "Esther Nieuwenhuis and {van Munster}, Sanne and Curvers, {Wouter L} and Weusten, {Bas L A M} and {Alvarez Herrero}, Lorenza and Auke Bogte and Alaa Alkhalaf and Schenk, {B E} and Koch, {Arjun Dave} and Spaander, {Manon C W} and Tang, {Thjon J} and Nagengast, {Wouter B} and Jessie Westerhof and Houben, {Martin H M G} and Bergman, {Jacques Jghm} and Schoon, {Erik J} and Pouw, {Roos E}",

note = "Funding Information: Dr. Weusten has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, and Aqua Medical. Dr. Bergman has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. The remaining authors declare that they have no conflict of interest. Publisher Copyright: {\textcopyright} 2022 The authors.",

year = "2022",

month = oct,

day = "1",

doi = "10.1055/a-1754-7309",

language = "English",

volume = "54",

pages = "936--944",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "10",

}

Nieuwenhuis, E, van Munster, S, Curvers, WL, Weusten, BLAM, Alvarez Herrero, L, Bogte, A, Alkhalaf, A, Schenk, BE, Koch, AD, Spaander, MCW, Tang, TJ, Nagengast, WB, Westerhof, J, Houben, MHMG, Bergman, JJ, Schoon, EJ & Pouw, RE 2022, 'Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals', Endoscopy, vol. 54, no. 10, pp. 936-944. https://doi.org/10.1055/a-1754-7309

TY - JOUR

T1 - Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals

AU - Nieuwenhuis, Esther

AU - van Munster, Sanne

AU - Curvers, Wouter L

AU - Weusten, Bas L A M

AU - Alvarez Herrero, Lorenza

AU - Bogte, Auke

AU - Alkhalaf, Alaa

AU - Schenk, B E

AU - Koch, Arjun Dave

AU - Spaander, Manon C W

AU - Tang, Thjon J

AU - Nagengast, Wouter B

AU - Westerhof, Jessie

AU - Houben, Martin H M G

AU - Bergman, Jacques Jghm

AU - Schoon, Erik J

AU - Pouw, Roos E

N1 - Funding Information: Dr. Weusten has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, and Aqua Medical. Dr. Bergman has received financial support for IRB-approved research from C2Therapeutics/Pentax Medical, Medtronic, and Aqua Medical. The remaining authors declare that they have no conflict of interest. Publisher Copyright: © 2022 The authors.

PY - 2022/10/1

Y1 - 2022/10/1

N2 - BACKGROUND : The optimal management for patients with low grade dysplasia (LGD) in Barrett's esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. "confirmed LGD"), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD. METHODS : This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC. RESULTS : Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE. CONCLUSION : One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.

AB - BACKGROUND : The optimal management for patients with low grade dysplasia (LGD) in Barrett's esophagus (BE) is unclear. According to the Dutch national guideline, all patients with LGD with histological confirmation of the diagnosis by an expert pathologist (i. e. "confirmed LGD"), are referred for a dedicated re-staging endoscopy at an expert center. We aimed to assess the diagnostic value of re-staging endoscopy by an expert endoscopist for patients with confirmed LGD. METHODS : This retrospective cohort study included all patients with flat BE diagnosed in a community hospital who had confirmed LGD and were referred to one of the nine Barrett Expert Centers (BECs) in the Netherlands. The primary outcome was the proportion of patients with prevalent high grade dysplasia (HGD) or cancer during re-staging in a BEC. RESULTS : Of the 248 patients with confirmed LGD, re-staging in the BEC revealed HGD or cancer in 23 % (57/248). In 79 % (45/57), HGD or cancer in a newly detected visible lesion was diagnosed. Of the remaining patients, re-staging in the BEC showed a second diagnosis of confirmed LGD in 68 % (168/248), while the remaining 9 % (23/248) had nondysplastic BE. CONCLUSION : One quarter of patients with apparent flat BE with confirmed LGD diagnosed in a community hospital had prevalent HGD or cancer after re-staging at an expert center. This endorses the advice to refer patients with confirmed LGD, including in the absence of visible lesions, to an expert center for re-staging endoscopy.

UR - http://www.scopus.com/inward/record.url?scp=85128598138&partnerID=8YFLogxK

U2 - 10.1055/a-1754-7309

DO - 10.1055/a-1754-7309

M3 - Article

C2 - 35098524

SN - 0013-726X

VL - 54

SP - 936

EP - 944

JO - Endoscopy

JF - Endoscopy

IS - 10

ER -

Impact of expert center endoscopic assessment of confirmed low grade dysplasia in Barrett's esophagus diagnosed in community hospitals

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