OAK BROOK, Ill. – August 27, 2012
Barrett's esophagus is a change in the lining of the esophagus due to chronic acid reflux and can be detected by endoscopy with biopsy. High-risk individuals with longstanding reflux should be screened with endoscopy for this condition. Barrett's esophagus is associated with an increased risk of developing esophageal adenocarcinoma (a form of cancer).
"The clinical problem addressed by this PIVI is the effectiveness and cost of current surveillance protocols, as well as rates of compliance with these protocols. Endoscopic surveillance of Barrett's esophagus (BE), as currently practiced, has shortcomings. Dysplasia (abnormal growth) and early adenocarcinoma may be endoscopically indistinguishable from non-dysplastic (benign) tissue. The distribution of dysplasia and cancer is highly variable, and even the most thorough biopsy surveillance program has the potential for a missed diagnosis due to sampling error. Current surveillance programs are expensive and time consuming," said PIVI Committee Co-Chair Prateek Sharma, MD. "Survey data indicate that while surveillance is widely practiced, there is marked variation from practice guidelines in the technique and interval of surveillance. A recent study found that adherence to guidelines occurred only 51 percent of the time and furthermore, the longer the length of the Barrett's segment, the worse the adherence."
The specific clinical issues addressed by this PIVI are what performance characteristics are required for an imaging technology to eliminate the need for random biopsies during endoscopic surveillance of patients with non-dysplastic Barrett's. The document outlines the following:
Thresholds recommended for this PIVI
Literature review summary
Areas for research
Training issues/establishment of competency
Other issues considered in establishing the thresholds
The PIVI committee (consisting of a committee of ASGE physician experts) in preparing the document, employed evidence-based methodology, using a MEDLINE and PubMed literature search to identify pertinent clinical studies on the topic. The PIVI is provided solely for educational and informational purposes and to support incorporating these endoscopic technologies into clinical practice. It should not be construed as establishing a legal standard of care. To read the full PIVI document, log on to ASGE's website at www.asge.org .
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