Format

Send to

Choose Destination
Gastrointest Endosc. 2016 Apr;83(4):736-42.e1. doi: 10.1016/j.gie.2015.08.020. Epub 2015 Aug 15.

Management of Barrett's high-grade dysplasia: initial results from a population-based national audit.

Author information

1
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Imperial College, Department of Surgery and Cancer, London, United Kingdom.
2
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
3
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.
4
Department of Gastroenterology, Northern General Hospital, Sheffield, United Kingdom.
5
Department of Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
6
Velindre Cancer Centre, Cardiff, Wales, United Kingdom.
7
Health and Social Care Information Centre, Leeds, United Kingdom.

Abstract

BACKGROUND AND AIMS:

Previous studies reported significant variation in the management of patients with Barrett's esophagus. However, these are based on self-reported clinical practice. The aim of this study was to examine the management of high-grade dysplasia in Barrett's esophagus in England by using patient-level data and to compare practice with guidelines.

METHODS:

From April 2012 to March 2013, National Health Service (NHS) trusts in England prospectively collected data on patients newly diagnosed with high-grade dysplasia (HGD) of the esophagus as part of the National Oesophago-Gastric Cancer Audit. Data were collected on patient characteristics, diagnosis and endoscopic findings, treatment planning, and therapy.

RESULTS:

Between April 2012 and March 2013, NHS trusts reported 465 cases of HGD. Diagnosis was confirmed by a second pathologist in 79.4% of cases (270/340), and 86.0% (374/465) had their treatment planned at a multidisciplinary team meeting. A total of 290 patients (62.4%) were managed endoscopically (frequently with endoscopic resection or radiofrequency ablation), whereas 26 patients (5.6%) had esophagectomy. The proportion of patients managed by surveillance varied by age (P < .001), ranging from 19.5% in patients aged <65 years to 63.8% in patients aged ≥85 years. More patients received active treatment if their cases were discussed at a multidisciplinary meeting (73.5% vs 44.3%; P < .001) or managed at higher-volume trusts (87.8% vs 55.4%; P < .001).

CONCLUSIONS:

There was marked variation in the management of HGD across England, with a third of patients receiving no active treatment. Patients discussed at a specialist multidisciplinary meeting or managed in high-volume trusts were more likely to receive active treatment.

PMID:
26283273
DOI:
10.1016/j.gie.2015.08.020
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center